肝内胆管乳头状肿瘤与肝脏黏液性囊性肿瘤的鉴别诊断  

Distinction between intraductal papillary neoplasms and hepatic mucinous cystic neoplasms

作　　者：周钦华 吕荣芬 张翠娟[3] 智绪亭[2] 陈泽婷[2] 陈阳[2] 侯金坪 毕建坤[2] 陈志强[2] 李涛[2] 

机构地区：[1]淄博市张店区人民医院普外科,255000 [2]济南山东大学齐鲁医院普外科 [3]济南山东大学齐鲁医院病理科

出　　处：《中华肝胆外科杂志》2014年第12期873-876,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（30901444）

摘　　要：目的 比较肝内胆管乳头状肿瘤（bIPN）与肝脏黏液性囊性肿瘤（MCN）的临床病理特点及鉴别诊断.方法 总结1998年1月至2013年7月收治的22例bIPN及14例MCN的临床资料,对其临床病理特点及预后进行对比分析.结果 bIPN患者年龄显著大于MCN患者[（59.7±10.8）岁比（44.9±9.6）岁;P＜0.001],但其肿瘤显著小于MCN患者[（5.5±3.3）cm比（11.7±5.4） cm;P =0.009].bIPN及MCN患者的临床症状均以腹痛为主（31.8％比35.7％;P=0.809）,但是bIPN患者较多伴有肝内胆管结石（40.9％比0;P =0.006）.bIPN肿瘤多位于肝左叶而MCN肿瘤多位于肝右叶（P=0.028）,bIPN肿瘤均与胆管相通而MCN肿瘤均与胆管不相通（P＜0.001）.bIPN肿瘤以恶性为主而MCN肿瘤以良性为主（81.8％比42.9％;P =0.029）,bIPN患者及MCN患者的5年生存率分别为85.3％和100％ （P =0.097）.结论 bIPN是具有与MCN不同临床病理学特点的胆管囊性肿瘤,手术切除是bIPN和MCN最佳治疗手段,预后较好.Objective To compare the clinicopathologic features of biliary intraductal papillary neoplasm （bIPN） and mucinous cystic neoplasms （MCN）.Methods The clinical,pathological and prognostic data of 22 patients with bIPN and 14 patients with MCN who underwent surgical treatment from January 1998 to July 2013 were retrospectively analyzed and compared.Results Patients with bIPN were significantly older than patients with MCN （59.7 ± 10.8 vs 44.9 ±9.6,P ＜0.001）.Tumors of the bIPN patients were much smaller than those of the MCN patients [（5.5 ± 3.3） cm vs （11.7 ± 5.4） cm,P =0.009].The main symptoms of both bIPN and MCN patients were abdominal pain （31.8％ vs 35.7％,P =0.809）,but bIPN patients were more commonly associated with hepatolithiasis （40.9％ vs 0,P =0.006）.The location of the mass differed,with bIPN usually occurring in the left lobe,whereas MCN in the right lobe （P =0.028）.Luminal communication between cystic tumors and bile ducts was detected in all surgically resected bIPN,which was significantly different from the MCN （100％ vs 0％ ; P ＜ 0.001）.Malignant lesions were more common in bIPN patients than in MCN patients （81.8％ vs 42.9％ ; P =0.029）.The overall 5-year survival rates of patients with bIPN and MCN were 85.3％ and 100％ respectively （P =0.097）.Conclusions bIPN represents a distinct clinicopathologic entity that differs clinically and histologically from MCN.Curative resection has a favorable prognosis for patients with bIPN or MCN.

关 键 词：肝脏 胆管 乳头状肿瘤 囊性肿瘤 诊断 鉴别 

分 类 号：R735[医药卫生—肿瘤]