胰管内乳头状黏液性肿瘤361例的临床特征

Intraductal papillary mucinous neoplasm of the pancreas： clinical characteristics and treatmentoutcomes of 361 patients

目的分析胰管内乳头状黏液性肿瘤（IPMN）的临床特征，以提高对该病的认识。方法采用单中心回顾性研究方法，分析长海医院1993年1月至2012年8月间收治的361例IPMN的临床资料，分析其临床特征。结果361例IPMN中，男性261例，女性100例，男女比例为2．6：1，平均年龄61岁（16～87岁）。其中主胰管型102例（28．3％），分支胰管型109例（30．2％），混合型150例（41．6％）。患者的症状主要为急性胰腺炎发作，共167例（46．3％）。内镜下胰胆管造影术（ERCP）的诊断符合率最高，为80．2％（130／162），MRCP、CT、内镜超声（EUS）的检查阳性率分别为76．9％（160／208）、63．9％（159／249）、50．5％（53／105）。手术治疗129例，病理诊断为腺瘤87例（67．2％），交界性21例（16．4％），浸润性癌11例（8．2％），原位癌10例（8．2％）。腺瘤及交界性IpMN患者的5年生存率为100％，恶性IPMN患者的5年生存率为66．5％，其中浸润性IPMN的5年生存率为44．7％。结论IPMN以60岁左右高发，近一半患者表现为急性胰腺炎发作，且发作逐渐频繁，混合型IPMN比例最高，影像学检查阳性率并不高，手术治疗效果好。

Objective To analyse the clinical characterization of intraductal papillary mucinous neoplasm of pancreas （IPMNs） and to improve the understanding of IPMNs. Methods Three hundred and sixty-one patients with IPMN at Shanghai Changhai Hospital between 1993 and 2012 were retrospectively analyzed. Results Among 361 cases of IPMNs, 241 were men and 120 were female, with a female to male ratio of 2.6： 1. Mean age of the patients was 62 years old （16 ~ 87 years old）. The duct type included the main duct in 102 patients （28.3%）, a branch duct in 109 （30.2%） , and mixed ducts in 150 （41.6%）. The most common symptom at presentation is pancreatitis, which occur in 167 patients （46. 3%）. The aensitivity for the detection of IPMN was 80.2% by ERCP, 76.9% by MRCP, 63.9% by CT, and 50.5% by EUS. One hundred and twenty-nine patients （35.7%） were operated and diagnosed with 87 （67.2%） IPMA, 21 （16.4%） IPMB, 10（8.2% ） IPMC（CIS） and 10 （8.2%） had invasive carcinomas. The 5-year survival rates of IPMA, IPMB, IPMC, and invasive carcinomas were 100%, 100%, 66.5%, and 44.7%, respectively.Conclusions IPMNs ~ere fl＇egrenlly occured is 60 yc^ars Ol（], half of patients had acute pan~＇realitis [ sto＇y and the [＇reqully allack, mixed type, is most ~ mtomy type, and the outcome after surgery is good.