Vignesh Shivakumar, Brugge William R
Division of Gastroenterology and Hepatology, Penn State College of Medicine, Hershey, PA 17033, USA.
J Clin Gastroenterol. 2008 May-Jun;42(5):493-506. doi: 10.1097/MCG.0b013e3181616159.
Pancreatic cystic neoplasms have emerged as an important new opportunity for many disciplines to participate in the diagnosis and management of early pancreatic neoplasia. With an increase in an understanding of these lesions and their potential for malignant transformation, there has been a dramatic increase in the frequency of diagnosis. We critically examined the literature on diagnostic methods for pancreatic cystic lesions over the past 5 years. The methods of endoscopic pancreatic pseudocyst drainage and clinical outcomes are also discussed. Morphologic studies of cystic lesions using cross-sectional imaging or endoscopic ultrasound have a low diagnostic rate. Cyst fluid analysis with the use of tumor markers (eg, carcinoembryonic antigen) increases the accuracy of diagnosis. The management of cystic lesions is heavily dependent on the type of cyst, the neoplastic potential, and the risk of surgery. The traditional therapy is pancreatic resection and not cyst enucleation. In contrast to cystic neoplasms, pseudocysts are localized collections of inflammatory fluid that mimic cystic neoplasms. The fluid collections arise from chronic pancreatitis and ductal leaks. Because pseudocysts have no neoplastic potential, they can be drained rather than resected. Drainage can be safely accomplished with external catheters or endoscopically with internal catheters. As we learn more about the pathophysiology of the various cystic lesions, treatment will be tailored to the specific cyst lesion. Endoscopic ultrasound has an important role in the characterization of pancreatic cystic lesions and helps in selection of the optimal treatment modality.
胰腺囊性肿瘤已成为多学科参与早期胰腺肿瘤诊断和管理的一个重要新契机。随着对这些病变及其恶性转化潜能认识的增加，诊断频率显著上升。我们严格审查了过去5年中关于胰腺囊性病变诊断方法的文献。还讨论了内镜下胰腺假性囊肿引流方法及临床结果。使用横断面成像或内镜超声对囊性病变进行形态学研究的诊断率较低。使用肿瘤标志物（如癌胚抗原）进行囊液分析可提高诊断准确性。囊性病变的管理很大程度上取决于囊肿类型、肿瘤潜能和手术风险。传统治疗方法是胰腺切除术而非囊肿摘除术。与囊性肿瘤不同，假性囊肿是模仿囊性肿瘤的炎性液体局部聚集。这些液体聚集源于慢性胰腺炎和导管渗漏。由于假性囊肿无肿瘤潜能，可进行引流而非切除。可通过外部导管安全地进行引流，也可在内镜下使用内部导管进行引流。随着我们对各种囊性病变病理生理学了解的增多，治疗将针对特定的囊肿病变进行调整。内镜超声在胰腺囊性病变的特征描述中具有重要作用，并有助于选择最佳治疗方式。
