胰腺囊性病变：单一机构 15 年时间内 1424 例患者的表现和治疗变化。
Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period.
机构信息
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
出版信息
J Am Coll Surg. 2011 Apr;212(4):590-600; discussion 600-3. doi: 10.1016/j.jamcollsurg.2011.01.016.
BACKGROUND
Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years.
STUDY DESIGN
A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010.
RESULTS
A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%.
CONCLUSION
Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection.
背景
胰腺囊性病变的检出率越来越高，现在建议采用选择性切除方法。本研究旨在评估在一家机构中，15 年来胰腺囊性病变的表现和治疗方式的变化。
研究设计
回顾了 1995 年至 2010 年间因 ICD-9 胰腺囊性病变诊断而接受评估的患者前瞻性维护的登记处。将 1995 年至 2005 年期间治疗的 539 例患者与 2005 年至 2010 年期间治疗的 885 例患者进行比较。
结果
共评估了 1424 例患者，其中 1141 例患者的随访时间>6 个月。初始治疗（首次评估后 6 个月内）手术治疗 422 例（37%），非手术治疗 719 例（63%）。最初接受手术切除的患者的手术死亡率为 0.7%（n=3）。非手术治疗患者的中位影像学随访时间为 28 个月（范围 6 至 175 个月）。接受影像学随访的患者更有可能患有无症状的囊肿（72%比 49%，p<0.001）、较小的囊肿（1.5cm 比 3cm，p<0.001）、无实性成分的囊肿（94%比 68%，p<0.001）和无主胰管扩张的囊肿（88%比 61%，p<0.001）。随后的手术治疗提示发生了 47 例（6.5%）变化，其中 8 例（17%）发现腺癌，4 例（8.5%）发现胰腺内分泌肿瘤。因此，在最初非手术治疗的 719 例患者中，有 12 例（1.7%）发现浸润性恶性肿瘤，其中 1.1%发现腺癌。
结论
胰腺囊性病变的检出率越来越高，但发生恶性肿瘤相关特征的可能性较小。经过精心选择的非手术治疗患者，其恶性肿瘤风险与最初接受手术切除的患者的手术死亡率风险相当。
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