Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
Dig Liver Dis. 2012 Mar;44(3):257-60. doi: 10.1016/j.dld.2011.09.010. Epub 2011 Oct 24.
It has been reported that main duct intraductal papillary mucinous neoplasms are more invasive and have a worse prognosis than branch duct intraductal papillary mucinous neoplasms. Therefore, an aggressive surgical approach has mainly been recommended for all MD-IPMNs. However, the surgical management of BD-IPMNs has been controversial and the consensus guidelines are not specific for an indicator of malignancy in BD-IPMNs. The objective of this study was to determine the proper management and follow-up strategy of BD-IPMNs.
We monitored and analysed patients with presumed BD-IPMNs between March 1995 and March 2010.
The mean value of the initial cyst size in all patients with BD-IPMNs was 2.19 cm. Amongst 194 patients with BD-IPMNs, 34 underwent immediate surgical resection, 152 were followed conservatively. Amongst the 152 conservatively managed patients, 18 (11.8%) underwent surgical resection after a median follow-up of 12.7 months (range, 3-48 months). In 132 patients who were managed conservatively without surgery, the mean incremental rate of cyst size growth was 0.0038 cm/month during a median of 30.7 months of follow-up and there were no IPMN-related deaths.
Amongst patients with BD-IPMNs, about 10% have surgery within approximately 1 year from the time of diagnosis because of the occurrence of new malignant stigmata. Therefore, a conservative approach without surgery and careful follow-up every 3 months or 6 months during the first year after diagnosis can be safely advocated in patients with BD-IPMNs larger than 10mm in size who have no risk factors for malignant IPMNs.
已有报道称，主胰管内乳头状黏液性肿瘤（MD-IPMN）比分支胰管内乳头状黏液性肿瘤（BD-IPMN）更具侵袭性，预后更差。因此，主要推荐对所有 MD-IPMN 采取积极的手术治疗方法。然而，BD-IPMN 的手术治疗一直存在争议，共识指南也没有针对 BD-IPMN 恶性肿瘤的具体指标。本研究旨在确定 BD-IPMN 的适当治疗和随访策略。
我们监测和分析了 1995 年 3 月至 2010 年 3 月期间疑似患有 BD-IPMN 的患者。
所有 BD-IPMN 患者的初始囊肿大小平均值为 2.19cm。在 194 例 BD-IPMN 患者中，34 例行即刻手术切除，152 例行保守治疗。在 152 例接受保守治疗的患者中，18 例（11.8%）在中位随访 12.7 个月（3-48 个月）后接受手术切除。在 132 例未接受手术而保守治疗的患者中，囊肿大小的平均增长率为 0.0038cm/月，中位随访时间为 30.7 个月，且无 IPMN 相关死亡病例。
在 BD-IPMN 患者中，约 10%的患者在诊断后约 1 年内因新发恶性特征而接受手术治疗。因此，对于直径大于 10mm 且无恶性 IPMN 风险因素的 BD-IPMN 患者，可以安全地提倡在诊断后第一年每 3 个月或 6 个月进行一次无需手术的保守治疗和密切随访。
