胰腺导管内乳头状黏液性肿瘤良恶性的术前鉴别

目的：比较良恶性胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplsms,IPMN）的不同临床特征。方法：回顾总结分析复旦大学附属中山医院1999年1月—2008年12月手术切除并经病理证实的70例资料完整的胰腺导管内乳头状黏液性肿瘤患者在临床表现？实验室检查结果及影像学特征等方面的差异,并对相关数据进行统计学分析。结果：70例IPMN患者中,良性21例（腺瘤15例,交界性肿瘤6例）,恶性49例（原位癌8例,浸润癌41例）;良恶性病例组在发病年龄、临床表现（皮肤及巩膜黄染、体质量下降、无症状患者、糖尿病）及实验室检查结果癌抗原19-9（CA19-9）升高、血糖升高、血总胆红素升高）]及影像学特征（囊肿附壁结节病例所占比率及肿瘤和主胰管平均直径）方面均有显著差异;两者在性别、肿瘤部位、腹痛及急性胰腺炎发病率、癌胚抗原（CEA）异常比率等方面无显著差异。结论：良恶性胰腺导管内乳头状黏液性肿瘤在临床表现,实验室检查及影像学特征方面存在一定的差异,对于术前两者的鉴别有一定的借鉴意义,并有助于治疗方式的选择。

Preoperative Differentiation of Intaductal Papillary Mucinous Neoplasms of the Pancreas

Objective：To investigate preoperative findings that are useful to distinguish benign or malignant intraductal papillary mucinous neoplasms（IPMN） of the pancreas.Methods： Retrospectively analysis of patients with IPMN underwent pancreatectomy in our unit from 1999 to 2008,preoperative predictive factors of malignant IPMN were analyzed clinically and radiologically.Statistical comparison was carried out between benign and malignant IPMN.Results： In the period,70 cases of IPMN,which consisted of 21 benign lesions（adenoma in 15,borderline in 6） and 59 malignant lesions（situ in 8 and invasive carcinoma in 41） were underwent pancreatectomy in our unit.Analysis result showed that the age,jaundice,loss of weight,asymptomatic cases,diabetes mellitus（DM）,tumor size,diameter of main pancreatic duct,mural module,and serum tumor marker CA 19-9 value were significant factors for malignancy,while gender,location,abdominal pain,pancreatitis,serum carcinoembryonic antigen（CEA） were no significant.Conclusions： There are some characteristics for IPMN are feasible to detect malignancy and useful for selecting an appropriate treatment.