胰腺导管内乳头状黏液肿瘤45例诊治分析

Diagnosis and treatment of 45 patients with pancreas intraductal papillary mucinous neoplasm

目的总结胰腺导管内乳头状黏液肿瘤(IPMN)的临床特征、影像学表现及其病理学特征,以提高对胰腺IPMN的临床诊治效果。方法回顾性分析苏州大学附属第一医院2014年2月至2019年2月期间行手术切除的胰腺IPMN患者的临床病理资料。结果本组共收集45例胰腺IPMN患者,其中男28例,女17例;年龄44~81岁、(65±21)岁,其中>60岁者35例。主要临床表现是上腹部不适(26例),主要发生在胰头部(20例);24例CT检查确诊(58.5%,24/41),17例MRI检查确诊(81.0%,17/21)。25例行胰十二指肠切除、5例行胰腺部分切除、2例行胰腺肿瘤切除术、12例行胰体尾切除术、1例行全胰腺切除。有23例病灶有不同程度的异型增生(轻度异型增生15例、中度异型增生5例、重度异型增生3例);6例侵及胰腺及其周围脂肪组织,5例侵及胰腺外组织。出院后采用电话随访3~24个月,随访了32例患者,失访13例,在所有随访患者中,1年生存率为100%(28/28),2年生存率为96.4%(27/28);患者术后3、6、12、18和24个月行CT检查复查,均未见淋巴结转移。结论胰腺IPMN在老年人多见,主要表现为消化道症状如上腹部不适等非特异性症状,患者术前诊断主要靠CT和MRI检查,但MRI检查阳性率较高,外科手术是其主要治疗手段,术后病理切片可见不同程度的异型增生。

Objective To summarize clinical features, imaging findings, and pathological characteristics of pancreas intraductal papillary mucinous neoplasm (IPMN) and to improve effect of clinical diagnosis and treatment of pancreas IPMN. Method The clinical data of 45 patients with pancreas IPMN who underwent surgical resection from February 2014 to February 2019 in the First Affiliated Hospital of Soochow University were retrospectively analyzed. Results Of the 45 patients with pancreas IPMN, 28 patients were male and 17 patients were female, aged from 44 to 81 years old with (65±21) years old. There were 35 patients with age > 60 years old. The most common clinical manifestation was the upper abdominal discomfort (26 patients) and the lesions mainly occurred in the head of pancreas (20 patients). Twenty-four (58.5%, 24/41) patients and 17 (81.0%, 17/21) patients were definitely diagnosed by the CT and MRI, respectively. Twenty-five patients underwent the pancreaticoduodenectomy, 5 patients underwent the partial pancreatectomy, 2 patient underwent the pancreatic tumor resection, 12 patients underwent the pancreatic body and tail resection, 1 patient underwent the total pancreatectomy. The pathological findings showed that 15 cases were mild dysplasia, 5 cases were moderate dysplasia, 3 cases were severe dysplasia. Six cases invaded the pancreas and its surrounding adipose tissue, 5 cases invaded the tissue outside the pancreas. After the discharge, 28/32 patients were followed up for 3 to 24 months. Among all the followed-up patients, the 1-year survival rate was 100%(28/28) and the 2-year survival rate was 96.4%(27/28). The patients underwent the CT examination on the 3rd, 6th, 12th,18th, and 24th month, no lymph node metastasis was found. Conclusions Pancreas IPMN is more common in the elderly, mainly manifests as gastrointestinal symptoms, such as upper abdominal discomfort, etc. Surgery is its main treatment mean. Preoperative diagnosis mainly depends on CT examination and MRI examination, but positive rate of MRI examination is higher. Postoperative pathological section shows different degree of dysplasia.