分支胰管型胰腺导管内乳头状黏液瘤临床分析

Clinical treatment of branch duct-intraductal papillary mucinous neoplasm

目的探讨分支胰管型胰腺导管内乳头状黏液瘤(BD-IPMN)的治疗策略。方法结合最新文献复习回顾性分析2例BD-IPMN患者的临床资料。对BD-IPMN的治疗策略、恶变预测等进行探讨,以提高对BD-IPMN的认识和治疗水平。结果2例患者手术过程顺利。患者1术后出现B级胰瘘,患者2出现一过性生化瘘,均经通畅引流、对症及支持治疗后顺利出院。患者1病理提示IPMN伴局灶导管周围腺体不典型增生。患者2病理提示IPMN伴上皮轻-中度异型增生。随访6~12个月,2例患者均未发生复发、转移。结论BD-IPMN作为一种低恶性潜能的肿瘤,尚缺乏有效的指标或方法精准预测其恶性潜能。手术是目前唯一有效的治疗方法,但外科治疗策略的制定需结合患者的依从性、意愿,以及预期寿命和手术风险等因素。应谨慎把握老年及有严重合并症患者的手术指征。

Objective To explore clinical treatment strategy of branch duct-intraductal papillary mucinous neoplasm(BD-IPMN).Methods In order to improve the clinical understanding and treatment of BD-IPMN, we analyzed the clinical treatment of two cases of BD-IPMN and discussed the clinical treatment strategy and factors of predicting malignancy of BD-IPMN in combination with the latest literature.Results Two patients were operated successfully. One patient had a grade B pancreatic fistula, the other had a transient biochemical fistula. All patients were discharged smoothly after unobstructed drainage and conservative treatment. One patient presented IPMN with atypical hyperplasia of the periductal glands. In the second patient, IPMN was associated with mild to moderate epithelial dysplasia. No recurrence or metastasis in both patients by followiong up for 6 months to 1 year.Conclusion As a kind of low malignant potential tumor, BD-IPMN still lacks effective indicators or methods to accurately predict the malignant potential, and its clinical treatment strategy is still controversial. However, through clinical practice and research of nearly 40 years, the understanding on BD-IPMN has been deepened, the clinical treatment strategy has gradually developed to the direction of evidence-based medicine, and the treatment strategy has become more conservative. In terms of treatment methods, surgery is the only effective method at present, but the formulation of surgical plan should be considered with the compliance and willingness of patients, as well as the factors such as life expectancy and surgical risk. The operation indication should be carefully considered especially for elderly patients and patients with serious complications.