胆管内与胰腺导管内乳头状黏液性肿瘤的比较  

Comparison between biliary tract intraductal papillary mucinous neoplasm and intraductal papillary mucinous neoplasm of the pancreas

作　　者：王幸[1] 陈拥华[1] 蔡云强[1] 赵法之[1] 谭春露[1] 柯能文[1] 刘续宝[1] 

机构地区：[1]四川大学华西医院肝胆胰外科,成都610041

出　　处：《中华肝胆外科杂志》2015年第9期620-624,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：卫生行业科研专项资金项目（201202007）

摘　　要：目的更好地认识胆管内乳头状黏液性肿瘤（BT-IPMN）与胰腺导管内乳头状黏液性肿瘤（P-1PMN）的关系。方法回顾性分析2008年1月至2013年12月在四川大学华西医院因胆道肿瘤接受手术治疗的182例患者中的ll例（6．0％）BT-IPMN患者和50例接受胰腺手术的P-IPMN患者资料。BT-IPMN患者年龄40-74岁，平均57．3岁。其中男性8例（73．0％）。P-IPMN年龄33～85岁，平均57．4岁，其中男性34例（68．0％）。对BT-IPMN的临床病理特点、影像学特点、手术策略及长期随访结果等进行总结，并与P-IPMN进行比较分析。结果BT-IPMN与P-IPMN两组患者在平均年龄、性别比例、临床表现[包括首要症状腹痛（73．0％比68．0％），CA19-9、CEA升高患者比例]等方面均无统计学差异。BT-IPMN组肿瘤平均直径小于P-IPMN组（1．7比4．1cm，P〈0．05）。11例BT-IPMN均存在肉眼可见的黏液分泌。胆管扩张（100％）和胆管腔内肿块（55．O％）是BT-IPMN最典型的影像学表现。BT-IPMN主要发生于肝内及肝门部胆管（82．0％）。左肝切除术（64．0％）是最常见的手术方式。1例患者由于肿瘤广泛侵及肝内外多处胆管，仅接受肿瘤活检和胆肠吻合的姑息性手术，于手术后第22个月死于肝功能衰竭。与P-IPMN相比，BT-IPMN似乎恶变风险更高（55．0％比44．0％）、预后更差（中位生存期，57比63个月），但差异均无统计学意义（P〉0．05）。结论BT-IPMN是一类罕见的胆管肿瘤，它与P-IPMN的部分临床病理特点具有相似性。在肿瘤完整切除后，BT-IPMN患者可以获得长期生存。Objective To compare biliary tract intraductal papillary mucinous neoplasm （BT- IPMN） with intraductal papillary mucinous neoplasm of the pancreas （P-IPMN）. Methods From January 2008 to December 2013, eleven （6. 0% ） cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors reseeted in our institution, while 50 cases underwent surgery for P-IPMN. The mean age of the 11 BT-IPMN cases was 57.3 years （range 40 to 74 years）. There were 8 men （73.0%）. The mean age of the 50 P-IPMN cases was 57.4 years （range 33 to 85 years）. There were 34 men （68. 0% ）. The clinical features, radiologic findings, pathology, surgical strategies, and long-term follow up outcomes between the 2 groups of patients were analyzed. Results There was no significant difference between BT- IPMN and P-IPMN in the following aspects： mean age, sex ratios and clinical presentation [ including the most common presenting symptom abdominal pain （73.0% vs. 68.0% ） , and elevated tumor markers （ CEA and CA19-9） ]. The mean tumor size of BT-IPMN was significantly smaller than P-IPMN （1.7 vs. 4.1 era, P 〈 0. 05 ）. Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports. The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation （ 100% ） and intraluminal masses （55.0%）. Most cases （82. 0% ） involved the intrahepatie bile duct and hilum. For tumor clearance, we conducted left hepatectomy in most cases （64. 0% ）. Only one patient un- derwent biopsy and choledochojejunostomy for muhiple tumors involving the extrahepatic, right and left bile ducts. BT-IPMN was likely to have a higher risk of malignancy （55.0% vs. 44. 0% ） and poorer prognosis （median survival, 57 vs. 63 months）, although there was no significant difference （P 〉 0. 05 ）. The patient without tumor resection died of liver failure 22 months after palliative surgery. Conclusions BT-IPMNs are very rare and they h

关 键 词：黏液性肿瘤 乳头状 囊性肿瘤 胆管 胰腺 

分 类 号：R735.9[医药卫生—肿瘤]