中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

胰腺囊性肿瘤术前良恶性判断

傅德良   

  1. 复旦大学附属华山医院胰腺外科 复旦大学胰腺病研究所，上海200040
  • 出版日期:2013-06-01 发布日期:2013-05-30

  • Online:2013-06-01 Published:2013-05-30

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摘要：

随着影像诊断技术的广泛应用和改进，胰腺囊性肿瘤（PCN）的诊断率不断增加。常见的胰腺囊性肿瘤包括浆液性囊腺瘤（SCN）、黏液性囊腺瘤（MCN）和导管内乳头状黏液性肿瘤（IPMN）以及囊实性假乳头状肿瘤（SPN），一旦怀疑为恶性时，均应行根治性手术切除。PCN的术前诊断和良恶性判断十分重要，目前主要依靠临床表现、影像学检查和实验室检查。当临床发现老年男性病人、血清肿瘤标记物CA19-9升高、伴有巨大胰腺肿块、体重下降、有特征性影像学表现者，应考虑恶性肿瘤的可能。主要依靠术后病理、经超声内镜下囊液抽取分析和穿刺组织活检确诊，包括肿瘤相关DNA、MicroRNA和蛋白质标记物的分析。

关键词: 胰腺囊性肿瘤, 浆液性囊腺瘤, 黏液性囊腺瘤, 导管内乳头状黏液性肿瘤

Abstract:

Preoperative diagnosis of the malignancy for pancreatic cystic neoplasms        FU De-liang. Department of Pancreatic Surgery of Huashan Hospital; Pancreatic Disease Institute; Shanghai Medical College, Fudan University, Shanghai 200040, China
Abstract    Pancreatic cystic neoplasms (PCN) are being increasingly detected due to widespread use of abdominal imaging and improved imaging techniques. The most common types of PCN are serous cystic neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN)and solid pseudopapillary neoplasm(SPN). Diagnosis of malignancy in PCNs cases requires radical pancreatectomy. Clinical， radiological and laboratory characteristics of PCNs may predict underlying malignancy, including male sex, abdominal mass, weight loss, larger tumor size, local invasion, and elevated CA19-9. Recent developments of clinical, radiological, and laboratory modalities used for preoperative diagnosis and differential diagnosis of PCNs are provided this review. Analysis of DNA mutations, microRNA and proteins within pancreatic cyst fluid by EUS-FNA have identified potential biomarkers to aid with the management of patients with pancreatic cystic neoplasms.

Key words: pancreatic cystic neoplasms, serous cystic neoplasms, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms