Rosien U, Layer P
Abteilung für Innere Medizin, Israelitisches Krankenhaus in Hamburg.
Med Klin (Munich). 1999 Jul 15;94(7):377-85. doi: 10.1007/BF03044902.
Most cystic lesions of the pancreas are pseudocysts caused by acute or chronic pancreatitis. Congenital cysts are rare and may occur in congenital syndromes like von Hippel-Lindau syndrome. Cystic tumors of the pancreas may be difficult to distinguish clinically; however, because of their malignant potential, in particular in cases of mucinous types, diagnostic verification is crucial. Hence, in all cases of cystic lesions of the pancreas, which are not a sequela of an etiological confirmed acute or chronic pancreatitis, a cystic neoplasm must be ruled out. Differential diagnosis may be difficult even with ultrasonography, computertomography, endoscopic retrograde cholangiopancreatography and serum analyses; endoscopic ultrasound, magnetic resonance tomography and analysis of the cyst content may be of particular value. The therapeutic approach for pseudocysts is now well established and guided by symptoms and complications. If a cystic neoplasm is suspected, surgical resection of the complete lesion is warranted.
The most important differential diagnosis in all cystic lesions of the pancreas with atypical presentation includes a cystic neoplasm. Therefore complete resection is indicated whenever the suspicion cannot be ruled out.
胰腺的大多数囊性病变是由急性或慢性胰腺炎引起的假性囊肿。先天性囊肿罕见，可发生于诸如冯·希佩尔－林道综合征等先天性综合征中。胰腺囊性肿瘤在临床上可能难以区分；然而，由于其潜在的恶性风险，特别是黏液性类型的病例，诊断性核实至关重要。因此，在所有并非已确诊病因的急性或慢性胰腺炎后遗症的胰腺囊性病变病例中，必须排除囊性肿瘤。即使采用超声检查、计算机断层扫描、内镜逆行胰胆管造影和血清分析，鉴别诊断也可能困难；内镜超声、磁共振断层扫描和囊肿内容物分析可能具有特殊价值。假性囊肿的治疗方法目前已很成熟，并以症状和并发症为指导。如果怀疑是囊性肿瘤，有必要对整个病变进行手术切除。
所有表现不典型的胰腺囊性病变最重要的鉴别诊断包括囊性肿瘤。因此，只要不能排除怀疑，就应进行完整切除。
