胰腺导管内乳头状黏液性肿瘤的临床表现与影像学特征

Clinical manifestation and imaging characteristics of ntroductal papillary mucinous neoplasm

目的探讨胰腺导管内乳头状黏性液瘤(IPMN)的临床特征及影像学的特征。方法回顾性分析2013年1月~2017年12月解放军总医院(301医院)收治的45例IPMN患者的临床资料、影像学资料、病理分型及治疗方式。结果45例IPMN患者中主胰管型(MD-IPMN)13例,分支胰管型28例(BD-IPMN),混合型4例(MT-IPMN)。术后病理提示低度异型增生25例,中度异型增生5例,高度异型增生4例,浸润癌11例。良性占所有患者的比例为77.8%,恶性占所有患者总数为22.2%。良恶性BD-IPMN患者主胰管直径及壁结节比较,差异有统计学意义(P<0.05),良恶性MD-IPMN及MT-IPMN患者的肿瘤大小、主胰管(MPD)直径以及壁结节的比较,差异有统计学意义(P<0.05)。影像学诊断IPMN良性的灵敏度为86.7%,特异度为73.3%,准确度为77.7%。结论影像学对IPMN良恶性的鉴别诊断具有一定的临床价值。

Objective To explore the clinical feature and imaging manifestations of introductal papillary mucinous neoplasm (IPMN). Methods The clinical features, imaging data and pathogical files of the 45 IPMN patients treated in PLA General Hospital from January 2013 to December 2017 were retrospectively analyzed. Results Of the 45 patient, 13 cases were with main duct type (MD-IPMN), 28 cases were with branch duct type (BD-IPMN), and 4 cases were with mixed pancreatic duct type (MT-IPMN). Postoperative pathology revealed 25 cases of low-grade dysplasi, 5 cases of moderate dysplasi, 4 cases of high dysplasia, 11 cases of invasive carcinoma. Benign diseases accounted for 77.8% of all patients, malignancy accounted for 22.2% of all patients. The difference of mural nudules and main pancreatic duct diameter between benign and malignant BD-IPMN patients was statistically significant (P<0.05). The difference of size of the cyst, mural nudules and main pancreatic duct diameter between benign and malignant MD-IPMN and MT-IPMN patients was statistically significant (P<0.05). The sensitivity, specificity and accurity of the imaging diagnoses of IPMN were 86.7%, 73.3% and 77.7%. Conclusion Imaging has clinical and diagnostic values in differential diagnosis of benign and malignant IPMN.