不同病理类型胰腺导管内乳头状黏液性肿瘤的临床分析  

Clinical and imageological features of different pancreatic intraductal papillary Mucinous tumors

作　　者：宋彬[1] 胡先贵[1] 金钢[1] 

机构地区：[1]第二军医大学附属长海医院胰腺外科,上海200433

出　　处：《医学研究生学报》2008年第5期513-516,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金面上项目(批准号:30772139)

摘　　要：目的:总结胰腺导管内乳头状黏液性肿瘤(IPMT)的诊治经验。方法:回顾性分析2003年5月至2005年12月经手术切除且病理证实的30例IPMT患者的临床资料,对IPMT的不同病理类型进行比较分析。将胰腺导管内乳头状黏液性囊腺瘤(IPMA)定为良性组,胰腺导管内乳头状黏液性囊腺癌(IPMC)和胰腺导管内乳头状黏液性交界性囊腺瘤(IPMB)归入恶性组。结果:恶性组男性易患率高于女性(76.5%vs30.8%,P<0.05);30例患者中IPMA 13例,IPMB 4例,IPMC 13例;主胰管型14例,分支胰管型15例,混合型1例主胰管型恶性率显著高于分支胰管型(P=0.030)。30例患者中21例有腹痛、腰背痛或消瘦等临床表现;影像学表现上,恶性组病灶囊内附壁结节的发生率高于良性组(P=0.025);主胰管型IPMT的主胰管直径(MPD)≥10 mm与<10 mm者、分支胰管型IPMT的肿瘤最大径>40mm与≤40mm者恶性率差异的比较有统计学意义(P<0.05)。结论:恶性IPMT好发于60岁左右老年男性;对IPMT患者可将病灶囊内是否存在结节以及主胰管直径、肿瘤大小等方面作为术前对IPMT进行良恶性鉴别的参考。Objective： To analyze the experience in the treatment of intraductal papillary Mucinous tumors （IPMT） of the pancreas. Methods： We retrospectively analyzed the clinical and imageological features of 30 IPMT patients, 17 males and 13 females, who underwent operations in our department from May 2003 to December 2005. The patients with intraductal papillary mucinous adenoma （IPMA） were included in the benign group, and those with intraductal papillary mucinous borderline tumor （IPMB） and intraductal papillary mucinous carcinoma （IPMC） in the malignant group. Results： There were more males than females in the malignant group （76.5% vs 30.8%, P 〈 0.05 ）. Of the total number, 13 cases were IPMA, 4 IPMB and 13 IPMC; 14 belonged to the main duct type, 15 the branch duct type and 1 the mixed type; 21 presented such clinical manifestations as abdominal pain, lumbodorsal pain and marasmus. Imageologically, more mural nodules were observed in the malignant than in the benign group, with the diameter of the main pancreatic duct ≥ 10 mm and the maxium diameter of the tumor 〉 40 mm, which were considered to be the predictors of malignancy. Conclusion： Clinical and imageological features differ signifcantly between different pathological types of IPMT. The presence or absence of mural nodules, the diameter of the main pancreatic duct and the size of the tumor may help differentiate the malignancy from benignancy of IPMT.

关 键 词：胰腺导管内乳头状黏液性肿瘤 诊断 鉴别 

分 类 号：R735.9[医药卫生—肿瘤]