胰腺导管内乳头状黏液性肿瘤的诊断与治疗

目的探讨胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasms,IPMN）的诊断和治疗。方法回顾性分析了28例胰腺导管内乳头状黏液性肿瘤的临床资料。结果28例IPMN患者主胰管型10例（35.7%）,分支胰管型7例（25%）,混合型11例（39.3%）,7例分支胰管型IPMN均为非浸润性IPMN;术后病理示腺瘤5例,交界性肿瘤12例,原位癌1例,浸润性IPMN10例。10例浸润性IPMN中有5例伴淋巴结转移,7例伴有神经侵犯,3例微血管侵犯,2例侵犯门静脉。行胰十二指肠切除18例,胰腺局部切除6例,胰体尾切除4例。结论胰腺导管内乳头状黏液性肿瘤是一种具有独特临床病理特征和预后较好的病变,积极合理的手术治疗可使患者获得良好的预后。

Diagnosis and treatment of intraductal papillary mucinous neoplasms in pancreas

Objective To study the clinical diagnosis and treatment of intraductal papillary mucinous neoplasm（IPMN） in pancreas.Methods Clinical and pathological data of 28 cases with IPMN in pancreas were analyzed retrospectively.Results Among the 28 patients,there were 10（35.7%） neoplasms located in main pancreatic duct,7（25%） in branch pancreatic duct and 11 in both main and branch duct.After operation pathology showed there were 5 IPMN adenoma,12 borderline IPMN,1 IPMN with carcinoma in situ,and 10 IPMN with invasive carcinoma.In 10 cases with invasive carcinoma,5 had lymph metastasis,7 had nerve invasion,3 had capillary invasion and 2 had portal vein invasion.Eighteen cases received pancreaticoduodenectomy,while 6 cases received local pancreas excision and 4 cases received pancreatic tail excision.Conclusion IPMN is different from pancreatic ductal carcinoma.Resection is the most effective treatment and better prognosis can be achieved after operation.