胰腺囊性肿瘤的诊治要点

Treatment of pancreatic cystic neoplasm

胰腺囊性肿瘤主要分为3类:浆液性囊性肿瘤(serous cystic neoplasm,SCN)、黏液性囊性肿瘤(mucinous cysticneoplasm,MCN)和导管内乳头状黏液性囊腺瘤(intraductal papillary mucinous neoplasm,IPMN)。SCN多为良性,恶性罕见,多是微囊腺瘤,典型表现呈蜂巢样结构。MCN有明显的恶性倾向,诊断多为体积较大且有分隔的囊肿。IPMN的特点是囊肿与胰管相通,伴有胰管扩张。囊肿的影像学特征是囊性肿瘤鉴别的主要依据,还应注意与实性假乳头状瘤(solid pseudopapillary tumors,SPT)和假性囊肿相鉴别。除了已经获得的明确诊断、肿瘤较小且无明显症状的SCN或较小的分支型IPMN之外,胰腺囊性肿瘤都应积极手术治疗。肿瘤完整切除的患者多数可以获得长期存活以上肿瘤的。具体手术方式应根据肿瘤所在部位、病理类型、与主胰管的关系、医师的经验以及患者全身情况综合考虑。

Pancreatic cystic neoplasm is mainly divided into three types,serous cystic neoplasm（SCN）,mucinous cystic neoplasm（MCN） and intraductal papillary mucinous tumor（IPMN）.SCN is mostly benign,rarely malignant,and mostly microcystadenoma.Classic appearance of SCN is honeycomb-like structure.MCN has obvious malignant tendency,mostly larger and separated cyst.The characteristic of IPMN is connection with the pancreatic duct which is usually dilatation.Imaging features of the cyst is the main evidence to identify the type of the cystic tumor.It should also be differentiated from solid pseudopapillary tumor（SPT） and pseudocyst.All the cystic tumors of pancreas,including those already got a clear diagnosis and small lesion without obvious symptoms or smaller IPMN of branch-type,should be treated with surgery.The majority can get long-term survival with complete tumor resection.Specific surgical approach should be based on tumor location,histological type,the relationship with the main pancreatic duct,the surgeon experience and the systemic situation of the patients.