内镜诊治胰腺导管内乳头状粘液性肿瘤的应用

目的探讨胰腺导管内乳头状粘液性肿瘤(IPMN)的诊断、内镜下治疗,以提高对该疾病的认识及内镜对其诊断及治疗的意义。方法回顾性分析经内镜诊治的IPMN患者12例,总结并分析他们的一般情况、临床症状、影像学检查、实验室检查、内镜下治疗等方面资料。结果 12例IPMN患者以老年男性为主,无特异性临床表现,主要发生部位为胰头或钩突部,CT主要表现为囊实性低密度影,其内可有壁结节,胰管扩张伴或不伴胆管扩张,2例侵及胰腺实质。磁共振胰胆管造影(MRCP)主要表现为胰管扩张,胰腺萎缩,胰头部圆形高信号影。内镜下逆行胰胆管造影(ERCP)显示十二指肠乳头膨大,开口扩张,可见胶冻样粘液流出,胰管造影显示胰管全程扩张或胰头部囊状扩张,3例伴胆总管、肝内胆管扩张。9例行ERCP治疗,清除粘液栓并置入胰管支架,3例同时置入胆管支架。结论 IPMN是一种特殊类型的胰腺囊性疾病,影像学检查有其独特的表现,ERCP对其诊断及治疗有重要意义。

Diagnosis and management of intraductal papillary mucinous neoplasm in pancreas(IPMN) by endoscopy

Objective To study the clinical diagnosis and treatment of intraductal papillary mucinous neoplasm in pancreas(IPMN) and evaluate the role of endoscopy in diagnosis and treatment.Methods The data of 12 patients with IPMN including general state of health,clinical characteristic of imaging findings,treatment by ERCP were retrospectively reviewed.Results This group is mainly of old men and no specific clinical information.CT demonstrated the cystic and solid lesion in the head or uncinate process of pancreas with mural nodules and dilatation of pancreatic duct.MRCP showed dilatation of pancreatic duct,high signal in the head of pancreas and atrophy of pancreas.ERCP was performed in all patients and found an abnormal protruding papilla of Vater with expulsion of mucous material,of whom 3 cases with dilatation of main pancreatic duct,5 cases with cystic dilatation of head pancreatic duct,3 cases with dilatation of bile duct at the same time.9 cases underwent treatment by routine ERCP and cleaned the mucous plug first and put the stand in pancreatic duct,and 3 cases were inserted with bile duct stent spontaneously.Conclusion IPMN is a special kind of cystic neoplasm of pancreatic with certain imaging findings,ERCP are helpful to make diagnosis and treatment.