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目的总结胰腺导管内乳头状粘液性肿瘤(IPMN)的临床病理特征及诊治经验,以提高对该疾病的认识和诊治水平。方法回顾性分析我院2003年7月至2011年8月收治的15例胰腺导管内乳头状粘液性肿瘤患者的临床资料。并结合相关文献复习讨论。结果本组15例胰腺导管内乳头状粘液性肿瘤患者,其中男性9例,女性6例,年龄35～78岁,平均(60.5±16.3)岁。血清CA199值23～108KU/L,平均(65.5±24.2)KU/L,CEA值均正常。患者术前常规行B超和CT或MRI检查,均提示有不同程度的胰管扩张。10例行ERCP检查,发现十二指肠乳头增大和粘液溢出者6例。均行手术切除治疗,胰十二指肠切除术10例,胰体尾联合脾脏切除术4例,保留十二指肠的胰头肿瘤切除术1例。术后病理诊断导管内乳头状粘液性腺癌4倒、导管内乳头状粘液性腺瘤伴局部癌变5例、导管内乳头状粘液性腺瘤6例。随访3个月-8年,患者均健在,最长1例已生存8年。结论临床表现无特异性,影像学检查发现胰腺有囊性占位伴胰管全程扩张的患者应考虑胰腺导管内乳头状粘液性肿瘤。术前要鉴别良恶性较困难,积极的手术治疗能获得较好预后。
Objective To summarize the clinicopathological features and diagnosis and treatment of papillary mucinous neoplasm (IPMN) in the pancreatic duct to improve the understanding and diagnosis and treatment of this disease. Methods The clinical data of 15 patients with intraductal papillary mucinous neoplasm in our hospital from July 2003 to August 2011 were retrospectively analyzed. Combined with the relevant literature review and discussion. Results The group of 15 patients with pancreatic ductal papillary mucinous tumors, including 9 males and 6 females, aged 35 to 78 years (mean, 60.5 ± 16.3 years). Serum CA199 value of 23 ~ 108KU / L, the average (65.5 ± 24.2) KU / L, CEA values were normal. Preoperative patients with conventional B-ultrasound and CT or MRI examination, suggesting that there are different degrees of pancreatic duct dilatation. 10 cases of ERCP examination, found that duodenal papilla and mucus overflow in 6 cases. All patients underwent surgical resection. Pancreaticoduodenectomy was performed in 10 cases, pancreatic body tail combined with splenectomy in 4 cases, and pancreaticoduodenectomy in 1 case. Pathological diagnosis of intraductal papillary mucinous adenocarcinoma down 4, intraductal papillary mucinous adenoma with local canceration in 5 cases, intraductal papillary mucinous adenoma in 6 cases. All cases were followed up for 3 months to 8 years, and the longest one had been alive for 8 years. Conclusion The clinical manifestations of nonspecific imaging found that pancreatic cystic lesions with full expansion of the pancreatic duct should consider pancreatic ductal papillary mucinous tumors. Preoperative identification of benign and malignant more difficult, positive surgical treatment can get a better prognosis.