Fujino Yasuhiro, Suzuki Yasuyuki, Yoshikawa Takuro, Ajiki Tetsuo, Ueda Takashi, Matsumoto Ippei, Kuroda Yoshikazu
Division of Gastroenterological Surgery, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
World J Surg. 2006 Oct;30(10):1909-14; discussion 1915. doi: 10.1007/s00268-006-0051-3.
Our objective was to evaluate outcomes of surgery for intraductal papillary mucinous neoplasms of the pancreas (IPMN) in terms of the clinicopathological features.
Fifty-seven patients with IPMN were examined using clinicopathological analyses to evaluate appropriate surgical treatment, including total pancreatectomy (TP). IPMN was classified into two types: main-duct type (MD, n = 33) and branch-duct type (BD, n = 24).
Ultrasound (US) and computed tomography (CT) examinations easily revealed the main site of the lesions. Intraoperative US was the most useful device for diagnosis of lateral spreading, and accuracy rates were 74% for MD and 96% for BD. TP was performed on 16 patients and was appropriate for removing neoplastic lesions with malignancy or malignant potential in 12. Three patients who underwent partial pancreatectomy with involved cancer died of progressive disease. MD is a strong predictive factor in malignancy and indicative of TP. Concerning long-term outcomes, 5 of 16 patients suffered from severe hypoglycemia, and 2 of 16 died from this condition.
Partial resection with cancer clearance was applied for BD-type IPMN. TP should be performed on selected patients with MD-type IPMN.
我们的目的是根据临床病理特征评估胰腺导管内乳头状黏液性肿瘤（IPMN）的手术效果。
采用临床病理分析对57例IPMN患者进行检查，以评估包括全胰切除术（TP）在内的合适手术治疗方法。IPMN分为两种类型：主胰管型（MD，n = 33）和分支胰管型（BD，n = 24）。
超声（US）和计算机断层扫描（CT）检查很容易显示病变的主要部位。术中超声是诊断侧向扩散最有用的设备，MD的准确率为74%，BD的准确率为96%。16例患者接受了TP，其中12例适合切除具有恶性或恶性潜能的肿瘤性病变。3例接受局部胰腺切除术且伴有癌症的患者死于疾病进展。MD是恶性肿瘤的一个强有力的预测因素，提示TP。关于长期预后，16例患者中有5例出现严重低血糖，16例中有2例死于这种情况。
BD型IPMN采用癌症清除的局部切除术。对于选定的MD型IPMN患者应进行TP。
