Gaujoux S, Dokmak S, Deschamps L, Zappa M, Belghiti J, Sauvanet A
Department of Hepatobiliary, Beaujon Hospital, AP-HP, University Paris-7, 100, boulevard du General-Leclerc, 92118 Clichy cedex, France.
Gastroenterol Clin Biol. 2008 Jan;32(1 Pt. 1):79-82. doi: 10.1016/j.gcb.2007.12.003. Epub 2008 Mar 4.
Intraductal papillary mucinous tumors (IPMT) of the pancreas are a distinct clinicopathological entity that is increasingly recognized and whose natural history and clinical presentation are now better understood. Nevertheless, only rare cases of pancreatobiliary or pancreatodigestive fistulas complicating IPMT have been described so far and their clinicopathological significance and association with cancer remain controversial. We report a case of pancreatocolonic fistula complicating a noninvasive IPMT, and review the published literature. Unlike previous reports, IPMT complicated by fistula in nearby organs does not seem to be more often associated with invasive carcinoma: frequency is comparable in resected IPMT with or without internal fistula. Since fistulas are not a reliable clinicopathological predictor of invasive malignancy, en-bloc resection should not be routinely performed especially if extended resection increases the immediate risks or the long-term risks of surgery.
胰腺导管内乳头状黏液性肿瘤（IPMT）是一种独特的临床病理实体，越来越受到认可，其自然病史和临床表现目前也得到了更好的理解。然而，迄今为止，仅有罕见的胰腺胆管或胰消化瘘并发IPMT的病例被描述，其临床病理意义以及与癌症的关联仍存在争议。我们报告1例非侵袭性IPMT并发胰结肠瘘的病例，并对已发表的文献进行综述。与既往报道不同，IPMT并发邻近器官瘘似乎并不更常与浸润性癌相关：在有或无内瘘的切除性IPMT中，其发生率相当。由于瘘并非浸润性恶性肿瘤可靠的临床病理预测指标，不应常规进行整块切除，尤其是当扩大切除会增加手术的近期风险或长期风险时。
