胰腺导管内乳头状黏液性肿瘤术后进展模式的分析
作者:
作者单位:

作者简介:

通讯作者:

中图分类号:

基金项目:

江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY2018059)


Analysis of postoperative progression pattern of pancreas intraductal papillary mucinous neoplasm
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    目的:分析胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)术后的进展模式及与进展相关的危险因素。方法:回顾性分析南京医科大学第一附属医院2010年3月—2019年12月手术切除、术后病理证实为IPMN的153例患者的临床及随访资料。根据进展病灶部位,将患者的进展模式分为:胰腺切除部位原位病灶生长、胰腺其他部位病灶生长和远处转移。分析各进展模式的比例、进展时间及影响进展的危险因素。结果:153例IPMN患者,其中,男107例(70%),中位年龄66岁(29~87岁),分支胰管型IPMN(branch duct IPMN,BD-IPMN)59例(39%),主胰管型IPMN(main duct IPMN,MD-IPMN)或混合型IPMN(mixed type IPMN,MT-IPMN)94例(61%)。术后病理显示低级别不典型增生(low grade dysplasia,LGD)88例(58%),高级别不典型增生(high grade dysplasia,HGD)28例(18%),导管内乳头状黏液癌(intraductal papillary mucinous carcinoma,IPMC)37例(24%)。共有14例(9%)患者术后出现进展,其中LGD 5例(36%),IPMC 9例(64%)。进展模式包括7例(50%)胰腺切除部位原位病灶生长、2例(14%)胰腺其他部位病灶生长、4例(29%)远处转移和1例(7%)胰腺切除部位原位病灶生长伴远处转移。12例(86%)患者的进展发生在术后5年内,而2例(14%)发生在术后5~10年。单因素分析提示术后病理是影响进展的危险因素(P < 0.001)。结论:虽然IPMN预后较好,但术后仍有较高的进展率,对IPMN患者术后进行规律及长期的随访十分必要。单因素分析提示术后病理是影响进展的危险因素。进展模式以胰腺切除部位的原位病灶生长为主,提示首次手术病灶切除不完全可能是进展的重要原因。

    Abstract:

    Objective:This study aims to analyze the postoperative progression pattern of intraductal papillary mucinous neoplasm(IPMN)and risk factors related. Methods:The clinical and follow-up data of 153 patients who received surgical resection and pathological confirmed of IPMN from 2010,March to 2019,December in the First Affiliated Hospital of Nanjing Medical University was retrospectively analyzed. According to the location of the progressive lesion,the progression patterns included:lesion growth at the pancreatic resection site,lesion growth in other parts of the pancreas,and distant metastasis. The proportion of each progress pattern,progress time and risk factors which affecting progress were analyzed. Results:Total 153 patients were included in the study group,107 patients were male(70%),median age was 66 years old(29-87 years old),59(39%)was branch duct IPMN(BD-IPMN),94(61%)was main duct IPMN(MD-IPMN)or mixed type IPMN(MT-IPMN). There were 88 cases(58%)with low grade dysplasia(LGD),28 cases(18%)with high grade dysplasia(HGD),and 37 cases(24%)with intraductal papillary mucinous carcinoma(IPMC). A total of 14 patients(9%)developed postoperative progression,including 5 patients(36%) with LGD and 9 patients with IPMC (64%). Progressive patterns included growth at the resected site in 7 cases(50%),growth at other sites in the pancreas in 2 cases(14%),distant metastasis in 4 cases(29%),and growth at the resected site combined with distant metastasis in 1 case(7%). Progression occurred within 5 years of surgery in 12 patients(86%)and 5 to 10 years after surgery in two patients(14%). Univariate analysis suggested that postoperative pathology was a risk factor for progression(P < 0.001). Conclusion:Although the prognosis of IPMN is good,there is still a high postoperative progression rate. It is necessary to conduct regular and long-term follow-up for patients with IPMN after surgery. Univariate analysis suggested that postoperative pathology was a risk factor affecting the progression. The progression pattern was mainly lesion growth at the resection site of the pancreas,suggesting that incomplete resection of the lesion during the first operation might be an important reason for the progression.

    参考文献
    相似文献
    引证文献
引用本文

王雪冰,邱辰杰,张 凯,涂 敏,蒋奎荣,苗 毅,高文涛.胰腺导管内乳头状黏液性肿瘤术后进展模式的分析[J].南京医科大学学报(自然科学版),2021,(5):696-700

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2021-02-09
  • 最后修改日期:
  • 录用日期:
  • 在线发布日期: 2021-06-02
  • 出版日期:
通知关闭
郑重声明