胰头占位性病变术前病理学诊断的必要性及指导性

Necessity and guidance of preoperative pathological diagnosis of space-occupying lesions of the head of pancreas

胰头占位性病变行胰十二指肠切除术前是否需要病理学诊断一直是胰腺外科研究的热点问题.目前国内外指南与共识均指出：术前判断胰头占位性病变具有手术切除指征,则无需病理学诊断.但对于可能切除的胰腺癌拟行新辅助治疗的患者、不可切除的胰腺癌拟行放化疗的患者、剖腹探查发现胰头占位性病变不可切除拟行姑息性短路手术的患者必须有病理学诊断后方可施行手术.外科医师在做出临床决策时,应注重多学科团队模式的运用、与患者及家属充分沟通、正确与辩证地看待指南和共识,以有效提高对胰头占位性病变的诊断与治疗水平.

The need of pathological diagnosis of spaceoccupying lesions of the head of pancreas before pancreaticoduodenectomy is a hot issue in the pancreatic surgery.According to the present guidelines and consensus,pathological diagnosis is not required if the patient with clinically resectable space-occupying lesions of the head of pancreas.However,confirmation of tumor malignancy is mandatory for patients with borderline resectable disease to be treated by neoadjuvant therapy,for patients with unresectable tumors to be treated by chemoradiotherapy,and for patients with unresectable tumors to be treated with a palliative bypass procedure during the surgical exploration.When making a clinical decision,surgeons should fully communicate with the patients and their relatives,under the direction of a multidisciplinary team,and have a correct and dialectical knowledge of the guidelines and consensus.This would be helpful for the improvements of the diagnosis and treatment of space-occupying lesions of the head of pancreas.