儿童胰腺实性假乳头状瘤18例临床诊治分析OA

Objective To investigate the diagnosis and treatment approaches as well as clinical prognosis of solid pseudopapillary neoplasm of pancreas(SPN)in children.Methods A retrospective analysis was conducted on clinical data of 18 SPN Children patients treated at Children's Hospital Affiliated to Zhengzhou University from October 2018 to July 2025.Preoperative auxiliary examinations,surgical techniques,postoperative complications,pathological characteristics,and clinical outcomes were systematically analyzed.Results All 18 cases underwent surgical resection,including 16 females and 2 males,with a median age of 11.2 years(range:6.2-14.0 years).Among these patients,12 presented with abdominal pain,4 were incidentally detected through physical examination,and 2 showed jaundice symptoms preoperatively.Comprehensive tumor marker assessments combined with ultrasonography,computed tomography(CT),and magnetic resonance imaging(MRI)were performed for all cases.Tumor locations included:pancreatic head(n=9)[5 patients received duodenum-preserving pancreatic head resection(DPPHR),1 patient received DPPHR+choledochojejunostomy,1 patient received pylorus-preserving pancreatoduodenectomy(PPPD),and 2 patients received enucleation(EN)],pancreatic body(n=1)[this patient received central pancreatectomy(CP)],and pancreatic tail(n=8)[all patients received spleen-preserving distal pancreatectomy(SPDP),including 2 laparoscopic SPDP].The median operation time was 352.5 minutes(range:145.0-585.0 minutes),and the median postoperative hospital stay was 30.5 days(range:11.0-90.0 days).Postoperative complications occurred in 5 cases(27.8%):one DPPHR case developed bile leakage after 2 weeks,and then was managed by ERCP placement of biliary stent;another DPPHR patient experienced intra-abdominal hemorrhage on postoperative day 4,which was managed by takedown of primary anastomosis and resection of approximately 5 cm of edematous intestinal segment followed by pancreaticojejunostomy reconstruction;exocrine dysfunction developed in one PPPD case after 1 month,which was conducted by long-term oral pancreatic enzyme supplementation;two EN cases encountered grade B pancreatic fistula on postoperative day 8 and day 11,respectively,one was managed conservatively with fasting and another was managed with subsequent jejunal fistula anastomosis in 6 months.Median follow-up duration was 56.3 months(range:8.0-90.8 months).No recurrence or metastasis was observed during follow-up.All patients achieved good recovery except Case 12 who required continuous pancreatic enzyme supplementation due to persistent exocrine insufficiency.Conclusion SPN represents a rare low-grade malignant pancreatic tumor in children.Surgical strategy centered on R0 resection with organ-preserving techniques,combined with standardized postoperative management and complication prevention,which can minimize surgical trauma,reduce long-term morbidity,and ensure favorable clinical outcome.