胰腺囊性肿瘤诊断和治疗研究进展

Advances in diagnosis and treatment of pancreatic cystic neoplasms

目的胰腺囊性肿瘤(pancreatic cystic neoplasm,PCN)缺乏特异性临床症状和体征,目前尚无统一的诊断标准和共识性诊疗指南,本研究通过回顾文献对各类型PCN在诊断方法和治疗策略作一综述。方法应用PubMed及中国知网(China national knowledge infrastructure,CNKI)期刊全文数据库检索系统,以"胰腺囊性肿瘤(pancreatic cystic neoplasm)、诊断(diagnosis)、治疗(therapy)"等为关键词,检索2010-01-2018-12文献。纳入标准:(1)PCN分类;(2)PCN诊断方法;(3)PCN治疗。根据纳入标准符合分析的英文文献45篇,中文文献3篇。结果胰腺囊性肿瘤病理分类复杂、解剖位置特殊、恶变风险因素不明确。虽有高分辨影像学、内镜、囊液分析及分子诊断等诊断方法,但对PCN仍难以进行准确分类,这导致不必要的检查和治疗。结论PCN准确的鉴别诊断至关重要,不同类型PCN有不同治疗方式。应联合影像学检查、囊液分析和分子标记物等检查,进一步区分各类PCN的生物学行为,以期让患者得到精准诊断和治疗。

OBJECTIVE Pancreatic cystic neoplasms(PCNs)lack specific clinical symptoms and signs,and there are no unified diagnostic criteria and consensus guidelines for diagnosis and treatment.This study reviewed the literature on the diagnosis and treatment strategies of various types of PCN.METHODS All references were searched in PubMed and China National Knowledge Infrastructure(CNKI)retrieval system with the keywords of"pancreatic cystic neoplasms,diagnosis,therapy"from January 2010 to December 2018.Inclusion criteria:(1)classification of PCN;(2)diagnostic methods of PCN;(3)treatment of PCN.According to the inclusion criteria,45 English and 3 Chinese literatures were analyzed.RESULTS PCNs have the features of complex pathological classifications,special anatomical location,and unclear malignant risk factors.Although there are diagnostic methods such as high-resolution imaging,endoscopy,cyst fluid analysis and molecular diagnosis,it is still difficult to accurately classify PCN,which leads to unnecessary examinations and treatments.CONCLUSIONS Accurate differential diagnosis of PCN is very important.Different types of PCN have different treatment methods.We should combine imaging examination,cystic fluid analysis and molecular markers to further distinguish the biological behavior of PCN,so that PCN patients can be accurately diagnosed and treated.