关键词: 胰腺囊性肿瘤, 指南, 循证医学证据

Abstract:

Current dilemmas and solutions in the management of pancreatic cystic neoplasms        LIANG Ting-bo, BAI Xue-li, MA Tao.  Department of Hepatobiliary-pancreas Surgery, the Second Affiliated Hospital, Medical School, Zhejiang University，Hangzhou 310003，China
Corresponding author: LIANG Ting-bo, E-mail:liangtingbo@
zju.edu.cn
Abstract    The increasing detection of pancreatic cystic neoplasms (PCN) makes them a group of popular diseases nowadays. However, many surgeons lack enough knowledge of such kind of disease, resulting in excessive or insufficient treatments. And there are still many puzzles and disagreements in the guidelines for diagnosis and treatment of PCN. The management principles of mucinous cystic neoplasm (MCN) and serous cystic neoplasm (SCN) are relatively clear. On the contrary, there are many debates in the management of IPMN. MRI is preferred in evaluating PCN, as it is superior to CT in the differential diagnosis. Endoscopic ultrasound is in the evaluation of PCN with relatively high sensitivity and specificity. For the treatment, surgery is rarely needed for SCN, and is usually warranted for MCN. Long-term follow-up is not needed for SCN and MCN without evidence of malignant transformation. Surgery is recommended for main-duct IPMN as it has significantly higher malignancy potential. However, there are still many dilemmas in the treatment of branch-duct IPMN (BD-IPMN). The management of BD-IPMN is roughly becoming conservative. Tumor size has became a much more important determiner for surgery. And the tumor growth rate and serum CA19-9 were recently recognized as important factors in guiding the surgical decision-making. A life-long follow-up is recommended for IPMN after surgery, as it has a high rate of recurrence, even in long duration.

Key words: pancreatic cystic neoplasm, guidelines, evidence-based medical studies