胰管内乳头状黏液瘤的临床特征分析  

Analysis of clinical features of intraductal papillary mucinous neoplasms of pancreas

作　　者：楼文晖[1] 靳大勇[1] 纪元[2] 许雪峰[2] 王单松[2] 

机构地区：[1]上海复旦大学附属中山医院普外科胰腺组,上海市200032 [2]上海复旦大学附属中山医院病理科,上海市200032

出　　处：《中华肝胆外科杂志》2006年第11期745-747,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的总结胰管内乳头状黏液性肿瘤(IPMNs)的临床表现,提高对该病的认识和诊治水平。方法回顾性分析自1999年5月到2005年8月底在我院普外科经手术切除且病理证实的42例胰管内乳头状黏液性肿瘤病例的临床表现、病理特征和随访资料。结果本组42例IPMNs,男26例、女16例;平均(63．3±10．4)岁;主要临床表现为腹痛和黄疸。胰十二指肠切除术36例,其中2例合并门静脉切除;胰体尾和脾切除术3例;全胰切除术1例;活检2例。围手术期死亡1例。全组主胰管型17例、分支胰管型14例、混合型11例;均有不同程度的胰管扩张(平均6．37mm)。按肿瘤侵袭性分,侵袭性组31例,非侵袭性组11例(良性、交界性和原位癌)。侵袭性IPMNs较非侵袭性IPMNs血清CA19-9值明显升高。按TNM分期,全组35恶性肿瘤中,0期6例,Ⅰ期15例,Ⅱ期9例,Ⅲ期5例。结论胰管内乳头状黏液性肿瘤无特异性临床表现,主要临床表现为腹痛和黄疸,胰管扩张是特征性影像学表现,侵袭性胰管内乳头状黏液性肿瘤血清CA19-9明显升高。Objective To investigate the diagnosis and treatment of intraductal papillary mucinous neoplasms （IPMN） of the pancreas. Methods The clinical data of 42 patients with IPMN of the pancreas treated in our hospital from May 1999 to August 2005 were retrospectively analyzed. Results Of the 42 patients with a mean age of 63.3±10.4 （41-81） years, 26 were male and 16 female. The major symptoms were abdominal pain and jaundice. Pancreatoduodenectomy was performed in 36 patients, total pancreatectomy in 1, distal pancreatectomy in 3 and pancreatic biopsy in 2. There was 1 case of perioperative death. Seventeen cases were of the main-duct type, 14 of the branch-duct type and 11 of the mixed type, Pancreatic duct dilation of various extents was the major sign of IPMN by CT scanning. IPMN without the evidence of invasive cancer was found in 11 patients and that associated with the invasive cancer was shown in the other 31. The serum CA199 level was significantly higher in the invasive group. Amongst the 35 cases of malignant IPMN, 6 were of stage 0, 15 of stage Ⅰ , 9 of stage Ⅱ and 5 of stage Ⅲ. Conclusions IPMN has no specific clinical manifestations and pancreatic duct dilation is a specific sign in imaging examination. The serum CA19-9 level is significantly higher in the invasive group.

关 键 词：胰腺肿瘤 症状 治疗 

分 类 号：R735.9[医药卫生—肿瘤]