目的    探讨胰腺囊性肿瘤病人外科治疗的指征及术式选择。 方法    回顾性分析北京大学第一医院1998-2012年门诊和住院诊治的229例胰腺囊性肿瘤病人的临床资料，手术治疗172例，对其中门诊随诊57例，观察并总结病人病灶进展、再手术及预后等情况；对行不同范围胰腺切除手术的167例病人的手术指征、术后并发症、生活质量及生存期进行分析和评价。结果    门诊随访的52例良性囊性肿瘤病人无相关新发症状，因肿瘤增长行手术治疗4例，病理证实为良性肿瘤，均获长期生存。外科手术治疗172例，手术切除率97.1%（167/172），总体手术并发症发生率为32.0%（55/172），围手术期病死率1.2%（2/172）。行肿瘤摘除术20例，胰体尾及脾切除术65例，保留脾脏的胰体尾切除术20例，胰腺中段切除术7例，Beger手术3例，胰十二指肠切除术54例，全胰切除术4例，胰体尾及联合脏器切除4例。非浸润性肿瘤治愈后长期生存，浸润性肿瘤1、3、5年存活率分别为89.6%、52.1%和29.2%。结论    符合良性肿瘤的无症状病人可随诊观察；手术方式以肿瘤性状为选择依据，应严格把握肿瘤局部切除的指征；针对局部进展和远处转移的晚期肿瘤病人，可选择性尝试联合脏器切除术。

Proper management strategy of cystic neoplasms of pancreas: experience from 229 cases        GAO Hong-qiao, WANG Jun, CHEN  Guo-wei, et al. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Corresponding author: YANG Yin-mo, E-mail: yangyinmo@263.net
Abstract    Objective    To investigate the effectiveness and safety of observation and different surgical procedure for cystic neoplasms of pancreas (CNP). Methods    From 1998 to 2012, The medical records of 229 patients refered to outpatient and inpatient were reviewed retrospectively. Morbidity and survival of surgical procedures were analysed. Long-term survivors were assessed using questionnaires. Results    52 outpatient patients with no evidence of malignancy were underwent regular surveillance and had long-term survival, no relevant new symptoms and death, 4 cases underwent surgical resection and  confirmed benign tumor. 172 patients underwent surgical managements. The overall postoperative morbidity rate was 32.0%(55/172), perioperative mortality rate was 1.2%（2/172）. Different pancreatectomy was performed in 167 cases (97.1%), enucleation in 20 cases, distal pancreatectomy with splenectomy in 65 cases, spleen-preserving distal pancreatectomy in 20 cases,  middle pancreatectomy in 7 cases, pancreatoduodenectomy in 54 cases, total pancreatectomy in 4 cases, pancreatectomy combined multi-organs resection in 4 cases. Patients with noninvasive neoplasms had long-term survival after cure and the 1,3,5 years’ survival rate for patients with invasive neoplasms was 89.6%, 52.1% and 29.2% ,respectively. Conclusions    Observation and waiting is feasible for benign CNPs of asymptomatic patients; Localized pancreatectomy is safe, but proper indication is important factors in achieving advantageous results; Local advanced and distant metastasis of CNPs, combined multi- organs resection may improve the prognosis.