胰腺导管内乳头状黏液性肿瘤的临床病理学分析(附29例报告)  

Clinicopathologic features of intraductal papillary mucinous tumors of the pancreas:analysis of 29 cases

作　　者：胡先贵[1] 金钢[1] 刘瑞[1] 张怡杰[1] 邵成浩[1] 唐岩[1] 

机构地区：[1]第二军医大学附属长海医院肝胆胰外科,上海200433

出　　处：《外科理论与实践》2007年第3期225-228,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:回顾性分析胰腺导管内乳头状黏液性肿瘤(IPMT)的诊治经验及预后,以期提高对该病的治疗水平。方法:1993年5月至2006年8月,共29例IPMT病人在我院接受手术治疗,男17例,女12例。现回顾性分析其临床表现、病理学分类以及术后随访情况。结果:术后病理证实,本组共有11例是类腺瘤,2例交界性肿瘤,16例腺癌。其中,主胰管型11例,分支胰管型16例,混合型2例。2例病人由于病变累及全胰而施行全胰切除术,其余病人分别施行胰十二指肠切除术(16例)、胰体尾切除术(7例)及局部切除术(4例)。在腺癌病例中,有37.5%(6/16)发生淋巴结转移。结论:IPMT有独特的临床病理学特征。对主胰管直径≥10mm、肿瘤直径>40mm以及主胰管型病例,应高度怀疑恶性病变的可能性。如术前考虑IPMT有恶性可能,则应施行合并淋巴结清扫的根治性切除术。Objective To analyze retrospectively our experience in treating intraductal papillary mucinous tumors （IPMT） of the pancreas, and to clarify the clinicopathologic characteristics and prognosis of this neoplasm. Methods During the period from May 1993 to August 2006, 29 patients with intraductal papillary mucinous tumor（IPMT）underwent operations in our institution. The clinicopathological features and follow-up results were analyzed retrospectively. Results Among all these patients, there were 11 adenomas, 2 borderline tumors, and 16 adenocarcinomas. The number of patients belonging to the main duct type, branch duct type and mixed type were 11, 16 and 2, respectively. Two patients underwent total pancreatectomy due to diffuse pancreatic involvement. The other cases underwent separately Whipple＇s operation （16 cases）, distal pancreatectomy （7 cases）, and local resection （4 cases）. The rate of lymph node metastasis was 37.5% （6/16） in the malignant cases. Conclusions Cases of IPMT demonstrate several distinct clinicopathologic types. Dilatation of the pancreatic duct to a diameter≥10 mm, large tumor size with a diameter〉 40 mm, and tumors involving the main pancreatic duct may be considered as predictors of malignant diseases. Radical resection with lymph node dissection should be considered in cases highly suspected of malignancy.

关 键 词：胰腺肿瘤 胰腺导管内乳头状黏液性肿瘤 诊断 病理学 外科 

分 类 号：R735.9[医药卫生—肿瘤]