不同病理类型的胰腺导管内乳头状黏液性肿瘤的临床特征

目的 总结不同病理类型胰腺导管内黏液性乳头状瘤(IPMT)的临床表现,提高对IPMT的诊治水平.方法 回顾分析1996年3月至2008年9月间经手术切除且病理证实的49例IPMT患者的临床表现、影像学特点及病理学特征,比较分析良性、交界性、恶性IPMT的临床表现.结果 49例IPMT患者中男27例,女22例,平均年龄(58±11)岁.良性19例,交界性9例,恶性21例.3类IPMT患者在性别、发病年龄、烟酒史、胰腺炎发作史、糖尿病病史,是否存在腹痛、腰背部放射痛、腹胀、腹泻、消瘦等症状,血CEA、AST、ALT水平,肿瘤位置及肿瘤分型上的差异均无明显统计学意义.但黄疸、术前CA19-9和碱性磷酸酶水平、肿瘤直径、主胰管直径、囊性肿瘤内是否存在隔膜、附壁结节的大小等方面的差异有统计学意义.恶性IPMT术后5年有1例病死,1例复发;交界性和良性IPMT有1例复发,1例因其他疾病病死.结论 不同病理类型的IPMT 临床特征存在一些差异,需综合判断进行鉴别.

Clinical features of different pathologic type of intraductal papillary mucinous tumors of the pancreas

Objective To summarize the clinical features of intraductal papillary mucinous tumors (IPMT) of the pancreas to improve the diagnosis and treatment of IPMT.Methods The clinical features,imaging features and clinicopatholagic characteristics of 49 IPMT patients,who underwent operations in our department from March 1996 to September 2008,were retrospectively analyzed.The clinical features of benign,borderline and malignant IPMT were compared.Results Among the 49 patients,there were 27 males and 22 females;the average age was 58±11 years.There were 18 benign cases,9 borderline cases and 22 malignant ones.The difference in sex ratio,age of disease onset,smoking and drinking habit,history of pancreatitis and diabetes,presence of abdominal pain,radiation pain,abdominal bloating and weight loss symptoms,serum levels of CEA,AST,ALT,tumor location and type were not significantly different between the 3 groups.However,there were significant difference in term of jaundice,serum carbohydrate antigen 19-9(CA19-9)and alkaline phosphatase (AKP) levels,size of tumor,diameter of main pancreatic duct,presence of septum in cystic tumor,mural modules in the tumor.Among the malignant IPMT patients,one patient died 5 years after operation,one patient had malignancy recurrence;among the benign and borderline IPMT patients,1 patient had malignancy recurrence and 1 patient died due to other disease.Conclusions Different types of IPMT had different clinical features and comprehensive judgment were needed to differentiate.