48例胰腺导管内乳头状黏液性肿瘤的诊治  

Diagnosis and treatment of 48 patients with intraductal papillary mucinous neoplasms of the pancreas

作　　者：白韬[1] 孙备[1] 陈华[1] 白雪巍[1] 王拥卫[1] 姜洪池[1] 

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001

出　　处：《中华肝胆外科杂志》2015年第7期470-473,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金资助项目（81170431,81372613,么81370565）;卫生公益性行业科研专项经费资助项目（201202007）;蛊高等学校博士学科点专项基金（20122307110012）

摘　　要：目的探讨胰腺导管内乳头状黏液性肿瘤（IPMN）的诊断和治疗策略。方法回顾性分析哈尔滨医科大学附属第一医院2006年1月至2014年4月经外科治疗且术后病理证实的胰腺导管内乳头状黏液性肿瘤患者的临床资料。48例患者中，男27例，女21例，平均年龄（57．8±8．8）岁。胰管平均直径（1．1±0．6）cm，分支胰管型肿瘤平均大小为（4．64-1．5）cm。结果胰十二指肠切除术35例，胰体尾加脾切除术8例，保留十二指肠的胰头切除术2例，保留脾脏的胰体尾切除术2例，全胰腺切除术1例。本组无围手术期死亡病例。患者术后平均住院时间为14．3d。术后病理：腺瘤5例（10．4％），交界性肿瘤12例（25．0％），原位癌14例（29．2％），浸润性癌17例（35．4％）。术后并发症总发生率22．9％。非浸润性肿瘤病例平均随访时间48．9个月，无一例复发或死亡。浸润性癌患者平均随访时间43．2个月，其中1例死亡，无复发病例。结论IPMN手术指征应根据专家共识和患者实际情况确定。IPMN的诊治应在胰腺外科中心实施。Objective To investigate the diagnosis and treatment of intraductal papillary mutinous neoplasm （IPMN） of the pancreas. Methods The clinical data of patients with pathologically verified IPMN who underwent surgical treatment between January 2006 to April 2014 in the First Affiliated Hospital of Harbin Medical University were studied retrospectively. There were 27 males and 21 females. The average age was （ 57.8 ± 8.8） years old. The average caliber of the main pancreatic duct was （ 1.1 ± 0.6 ） era. The average size of the branch duct IPMN was （4.6 ± 1.5） cm. Results 35 patients underwent pancreaticodu- odenectomy. Eight patients underwent distal pancreatectomy. Two patients underwent duodenum-preserving pancreatic head resection. Two patients underwent splenic-preserving distal pancreatectomy and one patient underwent total pancreatectomy. No patient died in perioperative period, and the median length of hospital stay after surgery was 14.3 days. Postoperative pathological examination revealed 5 （ 10.4% ） adenoma, 12 （25.0%） moderate-grade dysplasia, 14 （29.2%） high-grade dysplasia and 17 （35.4%） invasive carcino- ma. The postoperative complication rate was 22.9%. The mean follow up period for the noninvasive tumors was 48.9 months, with no recurrence or deaths. The mean follow up period of the invasive tumors was 43.2 months, with 1 death and no recurrence. Conclusions The indications for resection of IPMN should be based on treatment guidelines and on the patient＇ s general condition. It is suggested that the diagnosis and treatment of IPMN should be conducted in specialized pancreatic surgery centers.

关 键 词：胰腺肿瘤 导管内乳头状黏液性肿瘤 诊断 治疗 

分 类 号：R735.9[医药卫生—肿瘤]