58例胰腺导管内乳头状黏液性肿瘤临床分析

Clinical analysis of 58 cases of pancreatic intraductal papillary mucinous tumors

目的 探讨胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm,IPMN）的诊断和治疗.方法 回顾性分析2004年12月至2014年12月10年间收治58例IPMNs病人的临床资料、病理分型、治疗方式.男性36例,女性22例,男女比例为1.6∶1,年龄39～82岁,中位年龄67岁.58例IPMNs病人均行手术治疗.其中行胰十二指肠切除术31例（53.45％）,胰头部局部切除术9例（15.52％）,胰体尾切除术7例（12.07％）,胰体部局部切除术4例（6.90％）,胰尾切除术4例（6.90％）,胰尾联合脾切除1例（1.72％）,全胰腺切除2例（3.44％）.结果 58例IPMNs病人中主胰管型26例;分支胰管型9例;混合型23例;术后病理：腺瘤26例,交界瘤13例,非浸润癌10例,浸润性癌9例;全组的中位生存期为42.6个月;1、2和5年的生存率分别为94.5％、79.3％和65.5％.其中病理类型为浸润性癌的病人1、2、5年生存率分别为62.5％、47.5％、12.5％.结论 IPMN是一种比较罕见的肿瘤,手术治疗是目前比较好的治疗方式.

Objective To investigate the diagnosis and treatment of pancreatic intraductal papil- lary mucinous tumors （IPMNs）. Methods The clinical data, pathologic classification, and treatment of 58 cases of IPMNs admitted from Dec. 2004 to Dec. 2014 were retrospectively analyzed. Thirty-one cases were given pancreas duodenum resection, 9 cases pancreatic head mass local resection, 7 cases resection of pancreatic body and tail, 4 cases pancreatic body tumor resection, 4 cases pancreatic tail resection, 1 case pancreatic tail resection combined with splenectomy, and 2 cases total resection of pancreas. Results Of 58 cases of IPMNs, there were 26 cases of main pancreatic duct type, 9 cases of branch duct type, and 23 eases of mixed type. The postoperatively pathological examination confirmed 26 cases of adenoma, 13 cases of borderline tumor, 10 cases of non invasive carcinoma, and 9 cases of invasive carcinoma. The 1-, 2- and 5-year survival rate of all patients was 94. 5 %, 79. 3 % and 65.5 respectively. Conclusions IPMN is a rarer tumor, and surgical treatment is the optimal procedure.