Yale Pancreas Center and Interventional Endoscopy, Yale School of Medicine, New Haven, Connecticut, USA.
Gastroenterology. 2013 Jun;144(6):1303-15. doi: 10.1053/j.gastro.2013.01.073.
Approximately 10% of persons 70 years old or older are now diagnosed with pancreatic cysts, but it is not clear which ones require additional analysis, interventions, or follow-up. Primary care doctors rely on gastroenterologists for direction because no one wants to miss a diagnosis of pancreatic cancer, but meanwhile there is pressure to limit use of diagnostic tests and limit costs. We review the different cystic neoplasms of the pancreas and diagnostic strategies based on clinical features and imaging data. We discuss surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines. Intraductal papillary mucinous neoplasm (particularly the branch duct variant) is the lesion most frequently identified incidentally. We report what is known about its pathology, its risk of developing into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk. We also review surgical treatment and strategies for surveillance of pancreatic cysts.
现在，大约有 10%的 70 岁或以上的人被诊断出患有胰腺囊肿，但目前尚不清楚哪些胰腺囊肿需要进一步分析、干预或随访。初级保健医生依赖胃肠病学家的指导，因为没有人愿意错过胰腺癌的诊断，但与此同时，人们也面临着限制诊断测试使用和控制成本的压力。我们根据临床特征和影像学数据，回顾了不同的胰腺囊性肿瘤和诊断策略。我们根据最近修订的《仙台指南》，讨论了最常见的囊性肿瘤的手术和非手术治疗方法。胰管内乳头状黏液性肿瘤（特别是分支胰管型）是最常偶然发现的病变。我们报告了关于其病理学、发展为胰腺导管腺癌的风险、当前管理指南的优缺点，以及内镜超声在确定癌症风险方面的潜在作用。我们还回顾了胰腺囊肿的手术治疗和监测策略。
