Stevanović Dejan, Stojanović Dragoš, Mitrović Nebojia, Jašarović Damir, Milenković Sanja, Bokun-Vukašinović Zorana, Radovanović Dragan
Srp Arh Celok Lek. 2015 May-Jun;143(5-6):332-6. doi: 10.2298/sarh1506332s.
Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors.The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN.
A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8x5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease.
Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.
导管内乳头状黏液性肿瘤（IPMN）是胰腺最常见的囊性肿瘤之一，但仅占所有外分泌性胰腺肿瘤的1%-3%。随着诊断技术的发展，IPMN患者数量不断增加，约占所有接受手术治疗的胰腺肿瘤患者的20%。腹腔镜手术的发展推动了胰腺囊性肿瘤治疗的进步，但也给IPMN患者手术技术的选择带来了新的手术难题。
一名23岁患者因上腹部非特异性症状入院。诊断显示胰腺体部近端周边区域存在一个肿瘤形成，直径8×5厘米。囊性结构壁厚3毫米，充满致密内容物并侵入胰腺组织，但未导致胰管扩张。经过充分的术前准备后，患者接受了手术，术中使用超声刀对囊性肿瘤进行腹腔镜摘除，并凝固切断周边胰管与胰腺肿瘤之间的连通。标本的组织病理学分析显示为分支导管型IPMN（BD-IPMN），低级别异型增生。切除边缘无细胞异型性。免疫组化分析显示肿瘤黏液蛋白（MUC-5和MUC-2）呈阳性，这是胃型BD-IPMN的典型表现。术后六个月，患者无疾病复发迹象。
手术治疗是IPMN的主要治疗选择。尽管BD-IPMN的腹腔镜摘除术为微创手术，但能够达到足够的根治程度，且无相关并发症，术后恢复时间短。
