CAJ | 학술논문

目的更好地认识胆管内乳头状黏液性肿瘤(BT-IPMN)与胰腺导管内乳头状黏液性肿瘤(P-IPMN)的关系.方法回顾性分析2008年1月至2013年12月在四川大学华西医院因胆道肿瘤接受手术治疗的182例患者中的11例(6.0％) BT-IPMN患者和50例接受胰腺手术的P-IPMN患者资料.BT-IPMN患者年龄40 ～ 74岁,平均57.3岁.其中男性8例(73.0％).P-IPMN年龄33～85岁,平均57.4岁,其中男性34例(68.0％).对BT-IPMN的临床病理特点、影像学特点、手术策略及长期随访结果等进行总结,并与P-IPMN进行比较分析.结果 BT-IPMN与P-IPMN两组患者在平均年龄、性别比例、临床表现[包括首要症状腹痛(73.0％比68.0％),CA19-9、CEA升高患者比例]等方面均无统计学差异.BT-IPMN组肿瘤平均直径小于P-IPMN组(1.7比4.1 cm,P＜0.05).11例BT-IPMN均存在肉眼可见的黏液分泌.胆管扩张(100％)和胆管腔内肿块(55.0％)是BT-IPMN最典型的影像学表现.BT-IPMN主要发生于肝内及肝门部胆管(82.0％).左肝切除术(64.0％)是最常见的手术方式.1例患者由于肿瘤广泛侵及肝内外多处胆管,仅接受肿瘤活检和胆肠吻合的姑息性手术,于手术后第22个月死于肝功能衰竭.与P-IPMN相比,BT-IPMN似乎恶变风险更高(55.0％比44.0％)、预后更差(中位生存期,57比63个月),但差异均无统计学意义(P＞0.05).结论 BT-IPMN是一类罕见的胆管肿瘤,它与P-IPMN的部分临床病理特点具有相似性.在肿瘤完整切除后,BT-IPMN患者可以获得长期生存.
목적 경호지인식담관내유두상점액성종류(BT-IPMN)여이선도관내유두상점액성종류(P-IPMN)적관계.방법 회고성분석2008년1월지2013년12월재사천대학화서의원인담도종류접수수술치료적182례환자중적11례(6.0％) BT-IPMN환자화50례접수이선수술적P-IPMN환자자료.BT-IPMN환자년령40 ～ 74세,평균57.3세.기중남성8례(73.0％).P-IPMN년령33～85세,평균57.4세,기중남성34례(68.0％).대BT-IPMN적림상병리특점、영상학특점、수술책략급장기수방결과등진행총결,병여P-IPMN진행비교분석.결과 BT-IPMN여P-IPMN량조환자재평균년령、성별비례、림상표현[포괄수요증상복통(73.0％비68.0％),CA19-9、CEA승고환자비례]등방면균무통계학차이.BT-IPMN조종류평균직경소우P-IPMN조(1.7비4.1 cm,P＜0.05).11례BT-IPMN균존재육안가견적점액분비.담관확장(100％)화담관강내종괴(55.0％)시BT-IPMN최전형적영상학표현.BT-IPMN주요발생우간내급간문부담관(82.0％).좌간절제술(64.0％)시최상견적수술방식.1례환자유우종류엄범침급간내외다처담관,부접수종류활검화담장문합적고식성수술,우수술후제22개월사우간공능쇠갈.여P-IPMN상비,BT-IPMN사호악변풍험경고(55.0％비44.0％)、예후경차(중위생존기,57비63개월),단차이균무통계학의의(P＞0.05).결론 BT-IPMN시일류한견적담관종류,타여P-IPMN적부분림상병리특점구유상사성.재종류완정절제후,BT-IPMN환자가이획득장기생존.
Objective To compare biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) with intraductal papillary mucinous neoplasm of the pancreas (P-IPMN).Methods From January 2008 to December 2013,eleven (6.0％) cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors resected in our institution,while 50 cases underwent surgery for P-IPMN.The mean age of the 11 BT-IPMN cases was 57.3 years (range 40 to 74 years).There were 8 men (73.0％).The mean age of the 50 P-IPMN cases was 57.4 years (range 33 to 85 years).There were 34 men (68.0％).The clinical features,radiologic findings,pathology,surgical strategies,and long-term follow up outcomes between the 2 groups of patients were analyzed.Results There was no significant difference between BT-IPMN and P-IPMN in the following aspects:mean age,sex ratios and clinical presentation [including the most common presenting symptom abdominal pain (73.0％ vs.68.0％),and elevated tumor markers (CEA and CA19-9)].The mean tumor size of BT-IPMN was significantly smaller than P-IPMN (1.7 vs.4.1 cm,P ＜ 0.05).Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation (100％) and intraluminal masses (55.0％).Most cases (82.0％) involved the intrahepatic bile duct and hilum.For tumor clearance,we conducted left hepatectomy in most cases (64.0％).Only one patient underwent biopsy and choledochojejunostomy for multiple tumors involving the extrahepatic,right and left bile ducts.BT-IPMN was likely to have a higher risk of malignancy (55.0％ vs.44.0％) and poorer prognosis (median survival,57 vs.63 months),although there was no significant difference (P ＞ 0.05).The patient without tumor resection died of liver failure 22 months after palliative surgery.Conclusions BT-IPMNs are very rare and they had some similarity with P-IPMN.Complete resection of BT-IPMN is associated with good survival.