摘要
近年来,临床上胰腺囊性肿瘤(PCN)的病人越来越多,但外科医师对其认识不深,诊治水平参差不齐,从而导致了对PCN治疗上的不足或者过度。就PCN当前的国际诊治指南而言,不但存在较多的争议,而且也在不断的修正之中。黏液性囊腺瘤(MCN)及浆液性囊腺瘤(SCN)的诊治策略较为明确,而胰腺导管内乳头状黏液性肿瘤(IPMN)的诊治中存在的争议较多。MRI为PCN首选的非侵入性检查,因其在鉴别诊断上较CT有优势。内镜超声对PCN的诊断敏感性和特异性均较高,是PCN评估的重要组成部分。在治疗上,SCN一般无须手术;而MCN一旦确诊均建议手术切除,若无恶性证据无须术后随访。主胰管型IPMN因恶变率高,一旦确诊应积极手术治疗。分支胰管型IPMN(BD-IPMN)的治疗则存在不少争议,目前国际上对BD-IPMN的治疗总体趋于保守。在手术决策上,肿瘤大小越来越受到重视,肿瘤生长速度及血清CA19-9水平也在近期成为指导BD-IPMN治疗的重要因素。IPMN术后仍存在较高和较长期的复发风险,建议终身随访监测。
The increasing detection of pancreatic cystic neoplasms （PCN） makes them a group of popular diseases nowadays. However, many surgeons lack enough knowledge of such kind of disease, resulting in excessive or insufficient treatments. And there are still many puzzles and disagreements in the guidelines for diagnosis and treatment of PCN. The management principles of mucinous cystic neoplasm （MCN） and serous cystic neoplasm （SCN） are relatively clear. On the contrary, there are many debates in the management of IPMN. MRI is preferred in evaluating PCN, as it is superior to CT in the differential diagnosis. Endoscopic ultrasound is in the evaluation of PCN with relatively high sensitivity and specificity. For the treatment, surgery is rarely needed for SCN, and is usually warranted for MCN. Long-term follow-up is not needed for SCN and MCN without evidence of malignant transformation. Surgery is recommended for main-duct IPMN as it has significantly higher malignancy potential. However, there are still many dilemmas in the treatment of branch-duct IPMN （BD-IPMN）. The management of BD-IPMN is roughly becoming conservative. Tumor size has became a much more important determiner for surgery. And the tumor growth rate and serum CA19-9 were recently recognized as important factors in guiding the surgical decision-making. A life-long follow-up is recommended for IPMN after surgery, as it has a high rate of recurrence, even in long duration.
出处
《中国实用外科杂志》
CSCD
北大核心
2018年第1期48-52,共5页
Chinese Journal of Practical Surgery
关键词
胰腺囊性肿瘤
指南
循证医学证据
pancreatic cystic neoplasm
guidelines
evidence-based medical studies
