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目的提高对胰腺导管内乳头状黏液性肿瘤(IPMTs)的认识,以改善其诊治水平。方法对1993年5月至2003年12月收治的15例IPMTs病人的临床、影像学表现及病理资料作回顾性分析。结果15例中男性12例,女性3例。年龄33～76岁,平均58岁。上腹痛为最常见症状。B超和CT检查,均提示有不同程度的胰管扩张和囊实性占位。11例行ERCP检查,发现十二指肠乳头肿大和黏液溢出者7例。14例行手术治疗(胰十二指肠切除术12例,胰体尾切除1例,全胰切除1例)。术后病理诊断胰头导管内乳头状黏液性腺癌3例、导管内乳头状黏液性腺瘤伴局部癌变6例、胰头导管内乳头状黏液性腺瘤伴不典型增生3例、胰头导管内乳头状黏液性腺瘤2例,术后除1例因肝广泛转移而死亡外,其余病人均健在,存活期最长1例已13年。结论胰腺有囊实性占位伴胰管全程扩张的病人应考虑IPMTs,ERCP发现十二指肠乳头增大有黏液溢出者可确诊该疾病。手术切除是最有效的治疗,术后预后良好。
Objective To improve the understanding of intraductal papillary mucinous neoplasms (IPMTs) to improve their diagnosis and treatment. Methods The clinical, radiographic and pathological data of 15 patients with IPMTs admitted from May 1993 to December 2003 were analyzed retrospectively. Results In 15 cases, there were 12 males and 3 females. Age 33 to 76 years, mean 58 years. Upper abdominal pain is the most common symptom. B ultrasound and CT examination, all suggest different degrees of pancreatic duct dilatation and cystic solid occupancy. ERCP 11 routine examination revealed duodenal papilla swelling and mucus overflow in 7 cases. Fourteen patients underwent surgical treatment (pancreatoduodenectomy in 12 cases, pancreas tail resection in 1 case and pancreas resection in 1 case). Postoperative pathological diagnosis of pancreatic ductal papillary mucinous adenocarcinoma in 3 cases, intraductal papillary mucinous adenoma with local carcinogenesis in 6 cases, pancreatic ductal papillary mucinous adenoma with atypical hyperplasia in 3 cases, the pancreatic duct within the nipple 2 cases of mucinous adenoma, except one case died of extensive liver metastasis, the remaining patients were alive, the longest survival of 1 case has 13 years. Conclusions IPMTs should be considered in patients with cystic solid space and pancreatic duct full expansion in the pancreas. ERCP may be diagnosed by ERCP if the duodenal papilla is enlarged and there is mucus overflow. Surgery is the most effective treatment, the prognosis is good.