胰腺非浸润性导管内乳头状黏液肿瘤21例的临床分析

Clinical analysis of non-invasive intraductual papillary mucinous neoplasms of the pancreas in 21 cases

目的探讨非浸润性胰腺导管内乳头状黏液肿瘤的临床特征、治疗及预后。方法收集1999年1月—2005年12月中山医院手术切除的21例非浸润性胰腺导管内乳头状黏液肿瘤患者病历资料并对其进行随访,分析肿瘤的临床特征及手术治疗效果。结果21例非浸润性导管内乳头状黏液肿瘤中,男性17例,女性4例;12例为腺瘤,4例为交界性肿瘤,5例为原位癌;19例位于胰头,2例位于胰体尾;临床表现均以腹痛为主（11/21）,黄疸少见（3/21）,部分无症状（4/21）; CA19-9水平多正常（17/20）或仅轻度升高（3/20）,CT主要表现为囊性占位,其中5例可见病灶与主胰管相通。19例行胰十二指肠切除,2例行胰体尾切除,无手术死亡;术后20例患者得到随访,平均随访时间24个月,至随访结束,除1例失访,1例死于心肌梗塞外,其他患者均存活且未见肿瘤复发。结论非浸润性导管内乳头状黏液肿瘤手术治疗效果极佳,在其尚未恶变前予以切除能改善患者生存;对术后复发的评估可能需要长期的跟踪随访。

Objective To investigate the clinical characteristics, treatment and prognosis of non-invasive intraductal papillary mucious neoplasms （NVIPMN） of the pancreas. Method The clinical data of 21 patients undergoing NVIPMN resection of the pancreas were retrospectively analyzed. Result From Jan 1999 to Dec 2005,21 patients with NVIPMN underwent pancreatectomy in our hospital. Among them, 17 were male, 4 were female, with the average age of 62 years. Pathological diagnosis was adenomas （12 cases）, border-line neoplasms （4 cases）, carcinoma-in-situ （5 cases）, respectively. Six cases were of main pancreatic duct type, 12 cases were of branch pancreatic duct type and 3 cases were of mixed type. Most lesions were located in the head （ 19 cases）. Lesions were located in the tail or body of the pancreas in 2 cases. Abdominal pain was observed in 11 cases, jaundice was not very common （3 cases）. Four cases were asymptomatic. CT was performed in 15 cases, and cystic or low-density lesions （ 14/15 ） were the most common appearances. Communications between the lesions and main pancreatic duct were observed in 5 cases. The average diameter of the lesions was 3.9 cm. Postoperatively 20 cases were followed-up. The mean follow-up period was 24 months. One died of myocardial infarction, the other 19 cases were alive with no recurrence or metastasis. Conclusion Prognosis of the NVIPMN of the pancreas is good after pancreatectomy. Long-term follow up is necessary to definitely evaluate the benefit of pancreatomy for NVIPMN.