Surgical management of intraductal papillary mucinous tumor of the pancreas
Surgical management of intraductal papillary mucinous tumor of the pancreas
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DOI：
10.1067/msy.2002.125386
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发表时间：
2002-07-01
期刊：
影响因子：
3.8
通讯作者：
Imamura, M
中科院分区：
文献类型：
--
作者：
Doi, R;Fujimoto, K;Imamura, M
背景胰腺导管内乳头状黏液性肿瘤是胰腺囊性肿瘤的一种。IPMT包括导管内乳头状黏液性腺瘤（良性IPMT）和导管内乳头状黏液性癌（恶性IPMT）。恶性肿瘤的术前诊断是困难的，其侵袭性和转移性尚不清楚。本研究的目的是评估IPMT方法的最佳诊断和治疗策略。对京都大学医院确诊的38例IPMT患者的病历进行回顾性分析。分析术前影像学、手术方式、临床及病理表现。在38例IPMT中，CT定位正确率为82%，超声为90%，内镜逆行胰胆管造影为70%，磁共振胰胆管造影为100%，内镜超声为100%。超声内镜诊断恶性肿瘤的敏感性和特异性分别为81%和78%。38例IPMT患者中，20例首选保留幽门的胰腺切除术。22例患者有组织学恶性疾病。其中一半在邻近的间质中有浸润成分。1例恶性IPMT出现淋巴结转移，行胰十二指肠切除术联合区域淋巴结清扫术后无复发。无一例被诊断为切缘阳性;然而，27%的胰腺切缘上皮细胞显示异型增生伴增生。1例胰腺切缘肿瘤阴性的患者在残胰复发。恶性肿瘤的术前诊断是困难的，并且50%的恶性IPMT表现出侵袭性成分。因此，根治性胰腺切除加区域淋巴结清扫应是治疗的选择。手术治疗时应注意淋巴结转移和导管内远处侵犯。（Surgery 2002; 132：80-5.）。
Background. Intraductal papillary mucinous tumor (IPMT) is a type of pancreatic cystic neoplasm. IPMT consists of intraductal papillary mucinous adenoma (benign IPMT) and intraductal papillary mucinous carcinoma (malignant IPMT). Preoperative diagnosis of malignancy is difficult; the invasiveness and metastatic character are not well known. The Purpose of the study was to evaluate the optimal diagnostic and therapeutic strategy of IPMTMethods. Medical charts of 38 patients with final diagnosis of IPMT in Kyoto University Hospital were retrospectively reviewed. Preoperative imaging, mode of operation, and clinical and histopathologic findings were analyzed.Results. In 38 IPMTs, imaging of localization was correct in 82% by computed tomography, 90% by ultrasonography, 70% by endoscopic retrograde cholangiopancreatography, 100% by magnetic resonance cholangiopancreatography, and 100% by endoscopic ultrasonography. Evaluation of malignancy by endoscopic ultrasonography resulted in sensitivity and specificity of 81% and 78%, respectively. Pylorus-preserving pancreaticoduodenectomy was preferably performed in 20 of 38 patients with IPMT Twenty-two patients had histologically malignant disease. Half of them had an invasive component in the adjacent stroma. One case of malignant IPMT showed lymph node metastasis, and the patient had no recurrence after pancreaticoduodenectomy with regional lymphadenectomy. No case was diagnosed as margin positive; however, 27% showed a dysplasia with atypia in the epithelial cells of the cut edge of the pancreas. One patient with negative atypia at the cut edge of the pancreas developed a recurrent tumor in the remnant Pancreas.Conclusions. The preoperative diagnosis of malignancy is difficult, and 50% of malignant IPMT showed an invasive component. Thus, radical resection of the pancreas with regional lymph node dissection should be the choice of treatment. Lymph node metastasis and intraductal distant invasion should be carefully managed in the surgical treatment of these lesions. (Surgery 2002; 132:80-5.).