胰腺囊性肿瘤诊治中的几个热点与难点问题

Diagnosis and treatment of pancrean cystic neoplasms:hot and difficult problems

随着影像学技术手段的进步,胰腺囊性肿瘤的检出率显著增加。其主要包括浆液性囊腺瘤(SCN)、黏液性囊腺瘤(MCN)、导管内黏液性乳头状肿瘤(IPMN)及实性假乳头状瘤(SPN)等。由于不同类型之间、同一类型的不同亚型之间恶性潜能不同,诊断及治疗策略亦有较大差异。在微创理念指导下,提倡对有切除指征的囊性肿瘤行包括单纯切除、保留十二指肠的胰头切除术及胰腺中段切除术等。应严格掌控随诊观察与外科治疗的指征,既要避免治疗不足,也要避免治疗过度。

Cystic pancreatic neoplasms are often an incidental finding, the frequency of which is increasing. The understanding of such lesions has increased in recent years, but the numerous types of lesions involved can hinder differential diagnosis. They mainly include serous cystic neoplasms （SCN）~ mucinous cystic neoplasms （MCN）, intraductal papillary mucinous neoplasms（IPMN）, and solid pseudopapillary neoplasms （SPN）. Several of cystic pancreatic neoplasms can undergo malignant transformation and, therefore, require differentiated radiological and surgical managements. Because of minimally invasive approach, limited surgical procedures like enucleation, pancreatic middle segment resection or duodenum-preserving total or subtotal pancreatic head resection are recommended. The indication for follow-up or surgical intervention for patients with pancreatic cystic neoplasms should be controlled reasonably.