诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (02): 184-191.doi: 10.16150/j.1671-2870.2024.02.013
收稿日期:
2024-03-16
出版日期:
2024-04-25
发布日期:
2024-07-04
通讯作者:
柴维敏 E-mail: cwm11394@rjh.com.cn
GAO Meng, CHAI Weimin(), YAN Fuhua
Received:
2024-03-16
Published:
2024-04-25
Online:
2024-07-04
摘要:
胰腺囊性肿瘤(pancreatic cystic neoplasms, PCN)是指起源于胰腺导管上皮和(或)间质组织的囊性肿瘤性病变,大致可以分为黏液性肿瘤和非黏液性肿瘤。前者主要包括导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm, IPMN)、黏液性囊性肿瘤(mucinous cystic neoplasm, MCN),而后者主要包括浆液性囊性肿瘤(serous cystic neoplasm, SCN)、实性假乳头状肿瘤(solid-pseudopapillary neoplasm, SPN)和囊性神经内分泌肿瘤(cystic neuroendocrine tumor, cNET)。不同类型的PCN具有差异化的生物学行为,部分PCN存在恶变的风险,术前采用CT、MRI检查鉴别恶性肿瘤具有重要意义。MCN恶变率为5%~20%,恶性指征为直径大于等于4 cm,为手术指征。IPMN占PCN的22%,主胰管型及混合型IPMN恶变风险可高达70.9%和76.5%,分支胰管型IPMN的恶变风险为2.8%~10.7%。IPMN高危征象包括,强化的实质成分或壁结节直径≥5 mm、主胰管扩张(管径≥10 mm)、梗阻性黄疸,并推荐这些患者行手术治疗。SCN好发于中老年女性,男女比例为1:3,多为良性,浆液性囊腺癌罕见,仅占胰腺SCN的0.1%。2015版胰腺囊性疾病诊治指南推荐,所有的SPN均应行手术治疗。当SPN肿瘤包膜不完整、肿块直径大于6 cm或位于胰尾部可能具有较高的侵袭性和远处转移能力。cNET约占PCN的7%。PCN影像学诊断需结合病史及病变成分等,诊断要点为,MCN为几乎均发生于女性的胰体尾部类圆形、厚壁囊性肿瘤,常呈“囊内囊”表现;IPMN好发于老年男性,主胰管型IPMN表现为除外梗阻性因素的主胰管弥漫性明显扩张或节段性扩张,分支胰管型IPMN通常表现为与胰管相通的条管状囊性肿瘤,混合型IPMN则兼有两者表现;SCN为分叶状、薄壁寡囊或多囊蜂窝状肿瘤;SPN为好发于青年女性的较大类圆形囊实性肿瘤;cNET为边缘呈环形或新月形明显强化的囊实性肿瘤。国内外指南关于PCN手术指征的选择存在较大争议,且胰腺手术难度高、术后并发症多,给PCN的规范化治疗带来了挑战。识别PCN的影像学特点,明确影像学诊断,具有临床意义。
中图分类号:
高梦, 柴维敏, 严福华. 胰腺囊性肿瘤的CT/MRI诊断进展[J]. 诊断学理论与实践, 2024, 23(02): 184-191.
GAO Meng, CHAI Weimin, YAN Fuhua. Advance in study on diagnosis of pancreatic cystic tumors on CT/MRI imaging[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 184-191.
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