Fritz Stefan, Hackert Thilo, Büchler Markus W
Department of General and Visceral Surgery, University of Heidelberg, Heidelberg, Germany.
Dig Dis. 2015;33(1):99-105. doi: 10.1159/000368448. Epub 2014 Dec 17.
Cystic lesions of the pancreas are increasingly recognized due to the widespread use of modern abdominal imaging technologies. The majority of these lesions display pseudocysts and mucinous cystic neoplasms. In contrast to pseudocysts, it is well established that mucinous cystic neoplasms of the pancreas exhibit a significant potential for malignant transformation over time. Among mucinous cystic tumors, the most frequently observed entity is pancreatic intraductal papillary mucinous neoplasm (IPMN). IPMNs are characterized by cystic dilation of pancreatic ducts and the production of mucus and by an adenoma-carcinoma sequence eventually culminating in invasive carcinoma in some patients. Due to the high risk of harboring malignancy, there is international consensus that IPMNs with involvement of the main pancreatic duct should be recommended for surgical resection. To date, the indication for surgery of branch-duct IPMNs is controversially discussed because of the overall lower risk of malignant transformation compared to main-duct IPMNs. Particularly for small and asymptomatic side-branch IPMNs, the indication for surgical resection remains challenging. In addition to the international consensus guidelines, a number of potential preoperative features predicting malignant transformation have been discussed recently. Moreover, novel surgical pancreatic parenchyma-sparing techniques such as enucleations or segmental pancreatic resections have been reported in order to treat IPMNs. The present article aims to demonstrate the current scientific knowledge in this field and to highlight the current controversy.
由于现代腹部成像技术的广泛应用，胰腺囊性病变越来越受到关注。这些病变大多表现为假性囊肿和黏液性囊性肿瘤。与假性囊肿不同，胰腺黏液性囊性肿瘤随着时间的推移具有显著的恶变潜能，这一点已得到充分证实。在黏液性囊性肿瘤中，最常见的类型是胰腺导管内乳头状黏液性肿瘤（IPMN）。IPMN的特征是胰腺导管的囊性扩张、黏液分泌以及腺瘤-癌序列，最终在一些患者中发展为浸润性癌。由于存在恶变的高风险，国际上达成共识，对于累及主胰管的IPMN，应建议手术切除。迄今为止，由于与主胰管IPMN相比，分支胰管IPMN的总体恶变风险较低，其手术指征仍存在争议。特别是对于小的无症状分支IPMN，手术切除的指征仍然具有挑战性。除了国际共识指南外，最近还讨论了一些预测恶变的潜在术前特征。此外，为了治疗IPMN，还报道了一些新型的保留胰腺实质的手术技术，如摘除术或节段性胰腺切除术。本文旨在展示该领域的当前科学知识，并突出当前的争议。
