Brugge W R
GI Unit Blake 4, Massachusetts General Hospital, Boston, MA, United States.
Dig Liver Dis. 2008 Nov;40(11):854-9. doi: 10.1016/j.dld.2008.03.023. Epub 2008 May 27.
The management of pancreatic cystic lesions offers a challenge to clinicians. Mucinous cystic lesions pose a low risk of the development of neoplasia that must be taken into account in long-term management. Although the natural history has not been well defined, it is likely that malignant change in the mucinous epithelium takes place over years, very similar to what is observed with Barrett's esophagus. The traditional therapy of mucinous cystic lesions has been surgical resection. Lesions in the head of the pancreas will require a Whipple resection whereas tail lesions are managed with a distal pancreatectomy and splenectomy. In patients at high risk for surgical resection, the risk/benefit ratio may be excessively high, not supporting the use of resection therapy. Ethanol ablation therapy has been thoroughly studied in hepatic, renal, and thyroid cysts. Epithelial ablation with ethanol appears to be highly effective and relatively safe. Recently, ethanol ablation has been evaluated in pancreatic cystic neoplasms. In macrocystic lesions between 1 and 5 cm, ethanol lavage will result in epithelial ablation and cyst resolution in a high percentage of patients. Pancreatitis is rarely observed clinically and is not present in resection specimens. A randomised prospective clinical trial is currently underway.
胰腺囊性病变的管理给临床医生带来了挑战。黏液性囊性病变发生肿瘤形成的风险较低，这在长期管理中必须予以考虑。尽管其自然病程尚未完全明确，但黏液上皮的恶性变化可能发生在数年时间里，这与巴雷特食管的情况非常相似。黏液性囊性病变的传统治疗方法是手术切除。胰腺头部的病变需要进行惠普尔手术，而尾部病变则通过远端胰腺切除术和脾切除术进行处理。对于手术切除风险较高的患者，风险/收益比可能过高，不支持采用切除治疗。乙醇消融疗法已在肝囊肿、肾囊肿和甲状腺囊肿中得到充分研究。乙醇对上皮的消融似乎非常有效且相对安全。最近，乙醇消融已在胰腺囊性肿瘤中进行了评估。对于直径在1至5厘米之间的大囊性病变，乙醇灌洗将使高比例的患者实现上皮消融和囊肿消退。临床上很少观察到胰腺炎，切除标本中也不存在胰腺炎。目前正在进行一项随机前瞻性临床试验。
