胰腺导管内乳头状黏液性肿瘤的外科治疗及预后分析  

Individualized surgical treatment and prognosis of intraductal papillary mucinous neoplasms of the pancreas

作　　者：田孝东[1] 吴广东[1] 庄岩[1] 郭晓超[2] 杨尹默[1] 

机构地区：[1]北京大学第一医院普通外科,100034 [2]北京大学第一医院医学影像科,100034

出　　处：《中华外科杂志》2013年第7期588-591,共4页Chinese Journal of Surgery

摘　　要：目的 探讨胰腺导管内乳头状黏液性肿瘤（IPMN）的临床病理特征及预后.方法 回顾性研究2007年1月至2011年12月收治的56例胰腺IPMN患者的临床资料,分析不同类型IPMN的个体化治疗效果及预后.男性38例,女性18例,平均年龄（61±7）岁.其中主胰管型26例,分支胰管型18例,混合型12例.对累及主胰管或有临床症状的48例患者行手术治疗,包括胰十二指肠切除术29例,胰体尾切除术17例,全胰切除术2例.8例病灶最大径＜3 cm且无任何临床表现的分支胰管型患者未行手术治疗,予定期观察.结果 术后总并发症发生率为27.1％（13/48）,无围手术期死亡病例.术后病理证实非浸润性肿瘤31例;浸润性癌17例,其中淋巴结阳性7例.主胰管型、混合型和分支胰管型病例中浸润癌分别占46.2％（12/26）、3/12和2/18,组间比较差异有统计学意义（x2 =6.385,P =0.041）.非浸润性肿瘤与浸润性癌患者术后5年生存率分别为100％和24.6％;淋巴结阳性患者术后生存期低于淋巴结阴性的浸润性癌患者（P =0.017）.8例未行手术治疗患者随访期间病灶无明显变化.结论 IPMN恶性程度较低,进展缓慢,预后较好.累及主胰管的IPMN患者浸润性癌的比例较高,应积极手术治疗.最大径＜3 cm的无症状分支胰管型患者可密切随访.Objective To investigate the clinical manifestation, individualized surgical treatment, and prognosis of intraductal papillary mutinous neoplasms （ IPMN ） of pancreas. Methods The clinical data of 56 IPMN cases treated between January 2007 and December 2011 was retrospectively analyzed. Among the 56 patients （38 male and 18 female, mean age （61 _＋ 7） years）, 26 were main-duct type, 18 were branch-duct type, 12 were mixed type. Pancreatectomy was performed on 48 cases, including panereatieoduodenectomy on 29 patients, distal pancreatectomy on 17 patients, and total pancreatectomy on 2 patients. Results The overall postoperative morbidity rate was 27.1% （13/48）, there was no perioperative mortality. Pathology showed 31 cases of noninvasive IPMN, 17 cases of invasive IPMN, and 7 cases of lymph node metastasis. The rate of invasive tumors was 46. 2% （12/26） in main duct type, 3/12 in mixed type, and 2/18 in branch duct type IPMN, the difference was statistically significant （ X2 = 6. 385, P = 0. 041 ）. The five-year survival rate for patients with noninvasive and invasive neoplasms was 100% and 24.6%, respectively. The prognosis of invasive cases with lymph node metastasis was significantly worse than those without lymph node metastasis （ P = 0. 017 ）. A regular follow-up without surgical treatment was performed on 8 cases with asymptomatic side branch IPMN less than 3 cm in diameter, and no progression was found during the follow-up. Conclusions IPMN has a relative good prognosis. Main duct type and mixed type IPMN have a higher malignant potential, and should receive a surgical treatment. Patients of branch duct type IPMN with a 〈 3 cm diameter lesion and no clinical manifestations can be managed with close follow-up only.

关 键 词：胰腺肿瘤 乳头状瘤 胰腺切除术 预后 

分 类 号：R735.9[医药卫生—肿瘤]