胰腺导管内乳头状粘液性肿瘤的诊治

目的 总结胰腺导管内乳头状粘液性肿瘤（IPMT）的诊治经验，以提高对该疾病的认识和诊治水平。方法 自1993年5月至2000年8月共收治胰腺导管内乳头状粘液性肿瘤患者8例，男性6例，女性2例，年龄33-72岁，平均54岁，患者均行B超和CT检查，均提示有不同程度的胰管扩张，5例发现胰头囊实性占位，5例行ERCP检查，发现十二指肠乳头增大和粘液溢出者3例，血清CA19-9值6.5-108U/ml(平均66.88U/ml)，CEA值有1例为32.2ng/L，其余均为小于15ng/L。结果 8例患者中只有3例在入院时诊断为IPMT，除1命名中层得拒绝手术外，7例均进行了手术治疗（胰十二指肠切除术），术后病理诊断胰头导管内乳头状粘液性腺癌2例、胰头导管内乳头状粘液性腺瘤伴局部癌变2例、胰头导管内乳头状液性腺瘤伴不典型增生1例、胰头导内乳头状粘液性腺瘤2例，术后患者均健在，最长1例已6年，结论 胰腺有囊性占位伴胰管全程扩张的患者应考虑胰腺导管内乳头状粘液性肿瘤，ERCP发现十二指肠乳头有粘液溢出者可确诊该疾病，术前要鉴别良恶性较困难，手术切除是最有效的治疗，术后预后良好。

Diagnosis and treatment of intraductal papillary mucinous tumors of the pancreas

Objective To evaluate the diagnosis and treatment of patientswith intra ductal papillary mucinous tumors (IPMT) of the pancreas. Methods Of the 8 patients with IPMT of the pancreas treateb between May, 1993 and 2000 August, 8 in our hospital, 6 were male and 2 female (mean age, 54 years). B-ultrasound and CT scan were performed in all patients and demonstrated different extent dilatation of the main pancreatic duct. Cystic and solid lesions were found at the head of pancreas in 5 out of 8 patients. ERCP was performed in 5 patients, of whom 3 were found an abnormal protruding papilla of Vater with expulsion of mucous material. Serum CA19-9 was 6.5-108 U/L(mean 66.88 U/L), and CEA was less than 15 ng/L except 32.2 ng/L in 1 patient. Results Only 2 patients were diagnosed as having IPMT on admission. In 8 patients, 7 underwent pancreatoduodenectomy, and 1 refused operation. Postoperative pathological diagnosis showed intraductal papillary mucinous adenocarcinoma in 2 patients, intraductal papillary mucinous adenoma with partial cancerization in 2, intraductal papillary mucinous adenoma with atypical hyperplasia in 1, and intraductal papillary mucinous adenoma in 2. All patients are healthy after operation and 1 has been surviving 6 years. Conclusions IPMT should be taken into account when cystic lesion at the head of pancreas with a distended main pancreatic duct was found. Diagnosis can be confirmed when ERCP shows broad papilla with its expulsion of mucous material. Differential diagnosis of benign and malignant is difficult preoperatively. Resection is the most effective treatment and better prognosis can be achieved after operation.