脂肪胰与胰腺癌:从肿瘤发生到外科治疗

Pancreatic steatosis and pancreatic cancer: from cancer carcinogenesis to surgical management

肥胖症、饮酒及代谢性疾病等可引起脂肪细胞在胰腺组织中堆积和浸润, 导致脂肪胰的发生。脂肪胰临床关注较少, 尚未引起广大临床医师重视, 但前期研究结果证实其与胰腺癌发生、发展、手术并发症及预后密切相关。脂肪胰环境下脂肪细胞和巨噬细胞等炎症细胞在腺泡组织中聚集, 加重胰腺组织局部炎症状态, 刺激胰腺导管上皮不典型增生, 促进胰腺癌发生。脂肪胰患者发生胰腺癌的概率明显增高, 且更易出现淋巴结转移, 预后更差。脂肪胰状态下胰腺质地变软、变脆, 胰腺切除术后发生胰瘘及相关并发症风险明显增高。关于脂肪胰的诊断, 影像学检查方面, 常采用腹部平扫CT或磁共振成像检查;组织学检查方面, 胰腺腺泡组织中见大量脂肪细胞浸润可明确诊断脂肪胰。外科医师应提高对脂肪胰的重视程度, 熟悉其诊断标准及临床意义, 并对其进行积极预防和早期干预, 减少胰腺癌的发生。对于胰腺癌合并脂肪胰的患者, 围手术期应积极控制血糖、血压等代谢性疾病, 术中注重手术细节, 保证胰肠吻合质量, 减少术后并发症发生。笔者综合分析国内外相关研究进展并结合自身经验, 深入分析脂肪胰在胰腺癌发生、发展中的作用及对临床诊断与治疗的重要影响, 探讨合并脂肪胰的胰腺癌患者围手术期处理策略。

Obesity,alcohol consumption and metabolic diseases can cause the accumula-tion and infiltration of adipocytes in pancreatic tissues,resulting in pancreatic steatosis(PS).There is little clinical concern about PS,which has not yet attracted the attention of the physicians.How-ever,previous studies have confirmed that PS is associated with the carcinogenesis,development,surgical complications and prognosis of pancreatic cancer(PC).Within the environment of PS,adipocytes,macrophages and other inflammatory cells infiltrate among the acinar cells,aggravating the local inflammation in pancreatic tissue,stimulating the atypical hyperplasia of the pancreatic duct epithelium,and promoting the occurrence of PC.Patients with PS have a significantly higher incidence of PC and are more susceptible to lymph node metastasis,with worse long-term prognosis.The texture of pancreas become soft and fragile under the condition of PS,and the risk of pancreatic fistula and its related complications evidently increase after pancreatic resections.In terms of imaging examinations,it is common to use abdominal computed tomography or magnetic resonance imaging for the diagnosis of PS.In addition,a large number of adipocytes infiltration in pancreatic acinar tissue can confirm the diagnosis of PS histologically.Surgeons should pay more attention to PS,be familiar with its diagnostic criteria and clinical significance,and take active prevention and early intervention to reduce the occurrence of PC.Regard to PC patients complicated with PS,blood glucose,blood pressure and other metabolic diseases should be well controlled during the perioperative period,surgical details should be comprehensively considered to ensure the quality of pancreatojejunostomy and reduce postoperative complications.Combined with self-experience,the author comprehensively analyzes research advances at home and abroad,summarizes the role of PS in the occurrence and development of PC and its important influence on clinical diagnosis and treatment,and explores the perioperative management strategy of PC patients with PS.