良恶性胰腺导管内乳头状瘤的临床及影像特征

Clinical and radiological characteristics of benign and malignant intraductal papillary mucinous tumors of the pancreas

目的:探讨术前根据患者的临床表现特点以及影像学特征区分胰腺导管内乳头状黏液性肿瘤(IPMT)良、恶性的可能性。方法:回顾分析1996年7月至2007年3月间40例IPMT患者的临床及影像学资料。所有患者的病变均经术后病理明确诊断,其中良性病例17例,恶性病例23例。结果:从临床表现特点来看,恶性IPMT患者出现腹痛以及黄疸较良性患者更为常见(P<0.05),但两者在性别、发病率、发病年龄以及出现体质量减轻上无显著性差异;从影像学表现特征来看,恶性IPMT肿瘤大小及病灶内的附壁结节较良性IPMT为大(P<0.05),前者主胰管扩张常较后者明显(P<0.05),且更常出现附壁结节以及囊性病灶内不规则的隔膜(P<0.05),但两者在好发部位上无显著性差异。结论:恶性与良性IPMT患者在临床表现特点以及影像学表现特征的差异对术前诊断具有重要参考价值,从而为决定手术时机和(或)手术方式提供依据。

Objective： To discuss the feasibility of distinguishing benign from malignant intraductal papillary mucinous tumors （IPMT） of the pancreas preoperatively based on the clinical and radiological characteristics. Methods： The clinical data of 40 patients with IPMT treated between July 1996 and March 2007 were analyzed. The diagnoses of all patients were confirmed pathologically after surgical resections. Among the 40 patients, there were 17 benign eases and 23 malignant ones. Resuits： Malignant IPMT patients had a higher frequency of upper abdominal pain and jaundice than benign patients （P〈0.05）. The sex difference in incidence of IPMT, time of onset, and loss of body mass were not significantly different between the 2 groups. Radiological results demonstrated that the size of tumor and mural nodules in the lesions were larger in the malignant eases than in the benign cases （P〈0. 05） ; besides, the malignant cases also had a more dilated main pancreatic duet （MPD）（P 〈0.05）. Mural nodules and thick irregular septum in the cystic lesions were more frequently seen in malignant eases （P〈0. 05）. There was no significant difference in the site preference between the 2 groups. Conclusion： Benign and malignant IPMT have significant differences in their clinical and radiological characteristics, which provides an important evidence for differentiating the biological types of IPMT and helps surgeons on their decision of surgical planning.