胰管内乳头状黏液性肿瘤的诊断与治疗进展

Progress in diagnosis and treatment of intraductal papillary mucinous neoplasms

胰管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)是一种起源于主胰管及其导管分支上皮的罕见肿瘤.IPMN无特异性临床症状,早期诊断困难,常于体检时发现,磁共振胰胆管水成像、内镜超声及计算机断层扫描(computed tomography,CT)等影像学检查有助于术前诊断.IPMN生物学行为丰富多样,可通过增生-腺瘤-癌的方式逐步进展为恶性肿瘤;根据肿瘤在导管内发生的部位可将其分为主胰管型、分支胰管型和混合型.主胰管型和混合型由于恶性几率高,一经确诊,无论大小、有无症状,都应尽早手术.IPMN预后良好,侵袭性IPMN术后5年生存率达40%-60%,非侵袭性IPMN术后5年生存率更可达80%-100%.因此,IPMN的早期诊断及时治疗至关重要,本文就此方面做一综述.

Intraductal papillary mucinous neoplasm（IPMN） is a rare form of exocrine pancreaticneoplasm arising from the ductal epithelium,which is difficult to diagnose in early stages ow-ing to the lack of specific clinical symptoms. Inmost cases, IPMN is detected incidentally dur-ing medical examination. Some imaging studiessuch as magnetic resonance cholangiopancrea-tography（MRCP）, endoscopic ultrasonography（EUS） and computed tomography（CT） have been considered to be helpful to the preopera-tive diagnosis of IPMNs. Histologically, IPMNs may demonstrate a spectrum of cellular atypia, ranging from hyperplasia to invasive carcinoma. At present, IPMNs are classified into three types： main duct IPMN（MD-IPMN）, branch duct IPMN（BD-IPMN） and mixed type IPMN（MT-IPMN） according to the dominant location of the IPMN where the ductal dilatation occurs. Once diagnosed, all patients with MD-IPMN and MT-IPMN should undergo surgical resection as soon as possible regardless of size and symptoms due to the high risk of canceration. After surgical resection, the survival rate of IPMN patient is excellent. For patients with invasive IPMNs, the 5-year survival rate is 40%-60%, while for those with noninvasive IPMNs, the 5-year survival rate is 80%-100%. Therefore, early diagnosis and timely treatment are strongly recommended for all IPMN patients. The aim of this paper is to systematically review the diagnosis and treat-ment of IPMNs.