Kaiser J, Büchler M W, Hackert T
Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Chirurg. 2017 Nov;88(11):927-933. doi: 10.1007/s00104-017-0491-3.
Due to increasing precision of modern imaging modalities, intraductal papillary mucinous neoplasms (IPMN) of the pancreas are found with increasing prevalence. Despite their malignant potential IPMN are often kept under surveillance and are not immediately resected. The 2012 International Consensus Guidelines of Fukuoka have been widely accepted for the management of IPMN. They recommend surgical resection for branch duct IPMN with "high risk stigmata", while branch duct IPMN with "worrisome features" should undergo observation without immediate resection. Consequently, patients with asymptomatic branch duct IPMN and a presumed low malignant potential mostly undergo primary surveillance to avoid surgery-related morbidity and mortality following pancreatic resection; however, with respect to the cumulative risk of malignant transformation over time, surgical resection might also be indicated for patients with branch duct IPMN with "worrisome features". This article discusses the indications for surgery and different options of resection of branch duct IPMN.
由于现代成像方式的精度不断提高,胰腺导管内乳头状黏液性肿瘤(IPMN)的发现率日益增加。尽管IPMN具有恶变潜能,但通常会对其进行监测,并不立即进行切除。2012年的《福冈国际共识指南》已被广泛接受用于IPMN的管理。该指南建议,对于具有“高危特征”的分支导管IPMN应进行手术切除,而具有“可疑特征”的分支导管IPMN应进行观察,不立即切除。因此,无症状的分支导管IPMN且恶变潜能较低的患者大多接受初次监测,以避免胰腺切除术后与手术相关的发病率和死亡率;然而,考虑到随着时间推移恶变的累积风险,对于具有“可疑特征”的分支导管IPMN患者也可能需要进行手术切除。本文讨论了分支导管IPMN的手术指征和不同的切除选择。