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胰腺导管内乳头状黏液瘤(IPMN)是由胰腺导管内产生黏液的上皮细胞呈乳头状增殖形成的肿瘤。与经典胰腺癌相比,IPMN具有低度恶性、生长缓慢的特点。IPMN根据肿瘤累及的部位可分为主胰管型、分支胰管型和混合型。分支胰管型IPMN多为良性,主胰管型和混合胰管型IPMN的恶性可能性较大。IPMN临床表现多样且特异性差,多种影像学检查可显示弥漫性或节段性扩张的主胰管和囊状扩张的分支胰管,ERCP经扩大的乳头获取黏液和胰液,取胰腺导管内皮组织和壁结节活检有助于诊断。治疗根据肿瘤的性质采取不同方案。良性和交界性IPMN完整切除肿瘤即可,恶性IPMN一般需要根治性切除加淋巴结清扫术,对于无症状的分支胰管型,如无明显壁结节、细胞学检查阴性、囊肿小于30mm的可行临床观察。主胰管型和混合胰管型的IPMN则应全部手术切除。术中送冰冻病理确定手术范围,大多数手术患者采用胰十二指肠切除或胰体尾切除术,全胰切除仅占少数。IPMN手术切除率高,术后5年生存率高于一般的胰腺癌。本文就其临床表现、分类、病理特征、影像学诊断和治疗等方面进行综述。
Pancreatic papillary myxoma (IPMN) is a tumor formed by papillary proliferation of mucus-producing epithelial cells in the pancreatic duct. Compared with the classic pancreatic cancer, IPMN has low malignancy, slow growth characteristics. According to the site of IPMN tumor can be divided into the main pancreatic duct, pancreatic duct and mixed type. Branched pancreatic ductal IPMN mostly benign, pancreatic ductal and mixed pancreatic ductal IPMN malignant possibility. IPMN clinical manifestations of multiple and poor specificity, a variety of imaging examination can show diffuse or segmental expansion of the main pancreatic duct and cystic dilatation of the branch pancreatic duct, ERCP expansion of the nipple access to mucus and pancreatic juice, take pancreatic ductal endothelium And wall nodules biopsy helps diagnose. Treatment according to the nature of the tumor to take a different program. Benign and borderline IPMN complete resection of the tumor can be, malignant IPMN generally require radical resection plus lymph node dissection, asymptomatic branch and pancreatic duct type, such as no obvious wall nodules, cytology negative cysts less than 30mm feasible clinical Observed. The main pancreatic duct type and mixed pancreatic duct type IPMN should be all surgically removed. Frozen pathological surgery to determine the surgical range, the majority of surgical patients with pancreatoduodenectomy or pancreatic tail resection, total pancreatic resection only a minority. IPMN surgical resection rate, 5-year survival rate higher than the average of pancreatic cancer. This article reviews its clinical manifestations, classification, pathological features, imaging diagnosis and treatment.