Institute for Digestive Research and Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Am J Gastroenterol. 2010 Sep;105(9):1963-9. doi: 10.1038/ajg.2010.169. Epub 2010 Apr 20.
Successful treatment requires reliable preoperative assessment of the highly variable extension of intraductal papillary mucinous neoplasms (IPMNs). We aimed to determine the role of intraductal ultrasonography (IDUS) in predicting the extension of IPMN, and in selecting the method of pancreatic resection and the long-term outcome after surgery.
Randomized prospective study. Forty consecutive patients who underwent IPMN resection were included in the study. Patients were randomly assigned to an IDUS group or control group, in which IDUS was not performed.
Preoperative assessment by IDUS had an 85% (17 of 20) diagnostic accuracy for tumor extension of IPMN compared with 50% (10 of 20) in cases assessed by other imaging methods without IDUS (P=0.018). In 9 of 15 patients with invasive carcinoma, the tumor was located in the pancreatic head, and 11 had a main duct-type tumor. Recurrent disease was identified in 5 of 15 (33%) patients with invasive IPMN at a mean follow-up of 50 months; of them, 1 underwent preoperative IDUS and 4 were assessed by other imaging methods. None of the 25 patients with noninvasive IPMN had recurrent disease at follow-up. The overall cumulative 3-year survival rate was 79%.
Preoperative IDUS was useful in determining the type of surgery and the extent of resection, especially in main-duct IPMN.
成功的治疗需要可靠的术前评估，以确定高度变异的胰管内乳头状黏液性肿瘤（IPMN）的扩展范围。我们旨在确定腔内超声（IDUS）在预测 IPMN 扩展中的作用，并确定胰腺切除术的方法以及手术治疗后的长期结果。
这是一项随机前瞻性研究。纳入了 40 例接受 IPMN 切除术的患者。将患者随机分配至 IDUS 组或对照组，对照组不进行 IDUS。
与未行 IDUS 的其他影像学方法（10/20，50%）相比，术前 IDUS 对 IPMN 肿瘤扩展的诊断准确率为 85%（17/20）（P=0.018）。在 15 例浸润性癌患者中，肿瘤位于胰头部 9 例，主胰管型 11 例。在平均随访 50 个月时，发现 15 例浸润性 IPMN 中有 5 例（33%）患者出现复发性疾病；其中 1 例患者术前接受了 IDUS，4 例患者接受了其他影像学方法评估。25 例非浸润性 IPMN 患者在随访期间均未发生疾病复发。总的 3 年累积生存率为 79%。
术前 IDUS 有助于确定手术类型和切除范围，特别是在主胰管型 IPMN 中。
