Sugiyama M, Atomi Y, Saito M
First Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Gastrointest Endosc. 1998 Aug;48(2):164-71. doi: 10.1016/s0016-5107(98)70158-0.
We retrospectively analyzed the endoscopic ultrasonographic characteristics of intraductal papillary tumors of the pancreas and identified signs indicative of malignant tumors.
Twenty-eight patients with intraductal tumors and 38 with other pancreatic cystic lesions underwent endoscopic ultrasonography, conventional ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP).
Intraductal tumors were classified into three subtypes, and endoscopic ultrasonographic characteristics were assessed. In main duct type tumors, the main pancreatic duct showed a segmental or diffuse moderate-to-marked dilatation, often associated with intraductal nodules. Pancreatic parenchymal atrophy was frequently recognized. Branch duct type tumors consisted of multiple 5 to 20 mm cysts with the appearance of a cluster of grapes. The main duct was mildly dilated or nondilated. Combined type tumors had features of both main duct and branch duct types. Endoscopic ultrasonography (92%) differentiated pancreatic cystic lesions more precisely than ultrasonography (82%) and ERCP (89%). Main duct or combined type tumors, large tumors (> or = 30 mm for branch duct type), marked dilatation of the main pancreatic duct (> or = 10 mm for other types), and mural nodules suggested malignancy. Endoscopic ultrasonography demonstrated these signs more accurately than ultrasonography or ERCP.
Endoscopic ultrasonography is useful for diagnosing intraductal papillary tumors, particularly for predicting malignancy.
我们回顾性分析了胰腺导管内乳头状肿瘤的内镜超声特征，并确定了提示恶性肿瘤的征象。
28例导管内肿瘤患者和38例其他胰腺囊性病变患者接受了内镜超声检查、传统超声检查和内镜逆行胰胆管造影（ERCP）。
导管内肿瘤分为三个亚型，并评估了内镜超声特征。在主胰管型肿瘤中，主胰管呈节段性或弥漫性中度至明显扩张，常伴有导管内结节。胰腺实质萎缩常见。分支胰管型肿瘤由多个5至20毫米的囊肿组成，呈葡萄串样外观。主胰管轻度扩张或无扩张。混合型肿瘤具有主胰管型和分支胰管型的特征。内镜超声（92%）比超声（82%）和ERCP（89%）更能精确区分胰腺囊性病变。主胰管型或混合型肿瘤、大肿瘤（分支胰管型≥30毫米）、主胰管明显扩张（其他类型≥10毫米）和壁结节提示恶性。内镜超声比超声或ERCP更准确地显示这些征象。
内镜超声有助于诊断胰腺导管内乳头状肿瘤，特别是用于预测恶性肿瘤。
