Surgical Treatment for Intraductal Papillary Mucinous Tumor of the Pancreas
Surgical Treatment for Intraductal Papillary Mucinous Tumor of the Pancreas
复制标题
胰腺导管内乳头状粘液性肿瘤的手术治疗
DOI：
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发表时间：
2002
影响因子：
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通讯作者：
Y. Kim
中科院分区：
文献类型：
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作者：
W. Chang;J. Heo;J. Noh;T. Sohn;S. Choi;Y. Kim
目的：胰腺导管内乳头状粘液瘤（IPMT）患者的手术策略仍存在争议。在这项研究中，一系列患者的临床病理结果被用来合理化手术选择并重新评估全胰腺切除术的必要性。方法：1994年10月至2001年11月，对25例IPMT患者进行了手术。我们回顾性检查了临床病理特征和手术治疗。评估的因素包括：症状、肿瘤部位、手术类型、组织学结果、切除边缘、随访和生存。结果：胰十二指肠切除术是最常见的手术治疗（10 名患者：40%），其次是远端胰腺切除术（6 例）、保留幽门的胰十二指肠切除术（5 例）和全胰腺切除术（4 例）。组织学评估显示，11 名患者 (44%) 的肿瘤为腺瘤，8 名患者 (32%) 的肿瘤为交界性肿瘤，6 名患者 (24%) 的肿瘤为癌。没有手术或医院死亡。增生、腺瘤和非浸润癌病例全部存活。只有两名患有浸润性癌的患者死亡。两名患者（8%）的切除边缘存在轻度至中度不典型增生，一名患者存在癌。四名患者接受了全胰腺切除术。侵袭性癌患者的生存率与胰周淋巴结受累的存在显着相关。结论：我们的研究和文献回顾表明IPMT术前仍缺乏恶性指标。这些结果表明，IPMT 的治疗应采用切除术。有时，IPMT 的最佳治疗方法是全胰腺切除术，但一定要考虑较小的次全切除术。在选择治疗这些肿瘤的手术方法时，通过术中成像方式确认肿瘤的范围是有用的。对于有侵袭的情况，需要进行根治性切除。
Purpose: The surgical strategy for patients with a pancreatic intraductal papillary mucinous tumor (IPMT) is still controversial. In this study the clinicopathologic findings in a series of patients were used to rationalize surgical choice and reassess the need for a total pancreatectomy. Methods: Between Oct. 1994 and Nov. 2001, 25 patients with IPMT underwent surgery. We retrospectively examined the clinicopathologic features and surgical treatment. The factors evaluated included: symptoms, tumor site, operation type, histological findings, resection margin, follow-up and survival. Results: Pancreaticoduodenectomy was the most frequent surgical treatment (10 patients: 40%) followed by distal pancreatectomy (6), pylorus-preserving-pancreatico-duodenectomy (5) and total pancreatectomy (4). Histological assessment revealed the tumors to be an adenoma in 11 patients (44%), a borderline tumor in 8 patients (32%) and a carcinoma in 6 patients (24%). There were no operative or hospital deaths. All of the cases with hyperplasia, adenoma and noninvasive carcinoma survived. Only two of the patients with invasive carcinoma died. Mild to moderate dysplasia was present at the resection margin in two patients (8%), and carcinoma in one. A total pancreatectomy was performed in four patients. Invasive carcinoma patient survival was significantly associated with the presence of peripancreatic lymph node involvement. Conclusion: Our study and review of the literature indicates that preoperative indicators of malignancy in IPMT are still lacking. These results suggest that resection should be the treatment for IPMT. Sometimes IPMT is best treated by a total pancreatectomy, although lesser subtotal resections should definitely be considered. When selecting a surgical procedure for treating these tumors, it is useful to confirm the tumors’ extent by intra-operative imaging modalities. In the cases with invasion, a radical resection is required.