Department of Surgery, Kantonsspital St.Gallen, 9007, St.Gallen, Switzerland.
Langenbecks Arch Surg. 2013 Dec;398(8):1029-37. doi: 10.1007/s00423-013-1106-1. Epub 2013 Sep 3.
Cystic pancreatic tumors are being detected more frequently, and particularly, intraductal papillary mucinous neoplasia (IPMN) has recently attracted increased attention. The detection rate of IPMN has increased over the last decade; however, management of this neoplasm remains controversial.
Based on a review of the relevant literature and the international guidelines, we discuss the diagnostic evaluation of IPMN, its treatment, and prognosis.
While IPMN represents only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. It may not be possible to differentiate main duct disease from branch duct disease (MD-IPMN vs. BD-IPMN) prior to surgery. This distinction has not only an impact on treatment but also on prognosis, as MD-IPMN is more often malignant. IPMN has updated consensus guideline indications for conservative and surgical resection.
Since patients with IPMN of the pancreas are at risk of developing recurrent IPMN and pancreatic ductal adenocarcinoma in the remnant pancreas and extrapancreatic malignancies, early recognition, treatment, and systemic surveillance are of great importance. No conclusions can be drawn from the available evidence with respect to the efficacy of surveillance and follow-up treatment programs. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is mandatory to enable further diagnostic and treatment improvements.
胰腺囊性肿瘤的检出率越来越高，特别是近来人们对导管内乳头状黏液性肿瘤（IPMN）的关注度有所增加。在过去的十年中，IPMN 的检出率有所上升；然而，这种肿瘤的治疗方法仍存在争议。
我们通过对相关文献和国际指南的回顾，讨论了 IPMN 的诊断评估、治疗和预后。
虽然 IPMN 仅占所有胰腺癌的一小部分，但它们似乎是胰腺囊性肿瘤中一种相对常见的肿瘤形式。在手术前可能无法区分主胰管疾病和分支胰管疾病（MD-IPMN 与 BD-IPMN）。这种区别不仅对治疗有影响，而且对预后也有影响，因为 MD-IPMN 更常为恶性。IPMN 有更新的共识指南，规定了保守治疗和手术切除的适应证。
由于胰腺 IPMN 患者有在残胰和胰外部位发生复发性 IPMN 和胰腺导管腺癌的风险，因此早期识别、治疗和系统监测非常重要。目前尚无法从现有证据中得出关于监测和随访治疗方案的疗效的结论。为了进一步改善诊断和治疗，必须更好地了解 IPMN 的自然病程和胰腺癌的生物学特性。
