Jani Niraj, Bani Hani Murad, Schulick Richard D, Hruban Ralph H, Cunningham Steven C
Department of Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA.
Diagn Ther Endosc. 2011;2011:478913. doi: 10.1155/2011/478913. Epub 2011 Aug 22.
Pancreatic cysts are challenging lesions to diagnose and to treat. Determining which of the five most common diagnoses-pancreatic pseudocyst, serous cystic neoplasm (SCN), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal mucinous papillary neoplasm (IPMN)-is likely the correct one requires the careful integration of many historical, radiographic, laboratory, and other factors, and management is markedly different depending on the type of cystic lesion of the pancreas. Pseudocysts are generally distinguishable based on historical, clinical and radiographic characteristics, and among the others, the most important differentiation is between the mucin-producing MCN and IPMN (high risk for cancer) versus the serous SCN and SPN (low risk for cancer). EUS with FNA and cyst-fluid analysis will continue to play an important role in diagnosis. Among mucinous lesions, those that require treatment (resection currently) are any MCN, any MD IPMN, and BD IPMN larger than 3 cm, symptomatic, or with an associated mass, with the understanding that SCN or pseudocysts may be removed inadvertently due to diagnostic inaccuracy, and that a certain proportion of SPN will indeed be malignant at the time of removal. The role of ethanol ablation is under investigation as an alternative to resection in selected patients.
胰腺囊肿的诊断和治疗颇具挑战性。要确定五种最常见的诊断——胰腺假性囊肿、浆液性囊性肿瘤（SCN）、实性假乳头状肿瘤（SPN）、黏液性囊性肿瘤（MCN）和导管内乳头状黏液性肿瘤（IPMN）——中哪一种可能是正确的，需要仔细综合考虑诸多病史、影像学、实验室及其他因素，而且根据胰腺囊性病变的类型，治疗方法也有显著差异。假性囊肿通常可根据病史、临床和影像学特征加以区分，在其他类型中，最重要的鉴别是在产生黏液的MCN和IPMN（癌症风险高）与浆液性SCN和SPN（癌症风险低）之间。超声内镜引导下细针穿刺活检（EUS-FNA）及囊液分析在诊断中仍将发挥重要作用。在黏液性病变中，需要治疗（目前为手术切除）的包括任何MCN、任何主胰管型IPMN以及直径大于3 cm、有症状或伴有肿块的分支胰管型IPMN，同时要明白，由于诊断不准确，SCN或假性囊肿可能会被误切除，而且一定比例的SPN在切除时确实可能是恶性的。乙醇消融作为部分患者替代手术切除的一种方法，其作用正在研究中。
