Bournet Barbara, Kirzin Sylvain, Carrère Nicolas, Portier Guillaume, Otal Philippe, Selves Janick, Musso Carole, Suc Bertrand, Moreau Jacques, Fourtanier Gilles, Pradère Bernard, Lazorthes Franck, Escourrou Jean, Buscail Louis
Department of Gastroenterology, Centres Hospitaliers Universitaires Rangueil-Larrey and Purpan, Paul Sabatier University, Toulouse, France.
J Gastroenterol Hepatol. 2009 Jul;24(7):1211-7. doi: 10.1111/j.1440-1746.2009.05826.x. Epub 2009 May 19.
The aim of the present study was to assess the clinical fate of, and to gain new insights into, branch duct and mixed (predominantly main duct type) forms of intraductal papillary mucinous neoplasia of the pancreas (IPMN).
During a 17-year period, 99 successive IPMN patients (52 men, 47 women; mean age, 64 years) were included and divided into two groups for further comparison: one group had branch duct IPMN, whereas the other had mixed IPMN.
Patients from the mixed IPMN group (n = 52) displayed a greater rate of symptoms (83% vs 55%, P = 0.004), pancreatic resection (67% vs 38%, P = 0.007), malignancy (35% vs 13%, P = 0.017) and death (15% vs 4%, P = 0.09) than those from the branch duct IPMN group. A 38-month follow up of non-operated, symptom-free patients confirmed that more than 85% of branch duct IPMN patients were asymptomatic without evidence of malignancy. Borderline lesions and carcinoma are found in up to 50% of symptomatic resected branch duct IPMN cases.
Patients with the mixed form of IPMN as well as with symptomatic branch duct IPMN should require pancreatic resection because of symptoms and the risk for malignancy. In silent branch duct IPMN without radiological signs of malignancy, a non-operative watch-and-wait strategy can be discussed.
本研究旨在评估胰腺导管内乳头状黏液性肿瘤（IPMN）的分支导管型和混合型（主要为主导管型）的临床转归，并获得新的见解。
在17年期间，纳入了99例连续的IPMN患者（52例男性，47例女性；平均年龄64岁），并将其分为两组进行进一步比较：一组为分支导管型IPMN，另一组为混合型IPMN。
混合型IPMN组（n = 52）患者的症状发生率（83%对55%，P = 0.004）、胰腺切除术发生率（67%对38%，P = 0.007）、恶性肿瘤发生率（35%对13%，P = 0.017）和死亡率（15%对4%，P = 0.09）均高于分支导管型IPMN组。对未手术、无症状患者进行38个月的随访证实，超过85%的分支导管型IPMN患者无症状且无恶性肿瘤证据。在有症状的切除分支导管型IPMN病例中，高达50%发现有交界性病变和癌。
由于存在症状和恶性肿瘤风险，混合型IPMN患者以及有症状的分支导管型IPMN患者应接受胰腺切除术。对于无恶性肿瘤放射学征象的无症状分支导管型IPMN，可讨论采取非手术观察等待策略。
