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IPMN伴瘘管形成的研究进展
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Abstract:
在胰腺导管内乳头状黏液性肿瘤(Intraductal papillary mucinous neoplasm, IPMN)患者中，合并瘘管形成是一种罕见但重要的并发症。研究表明，IPMN可通过机械穿透或自身消化等机制形成瘘管，导致其向邻近器官扩展。瘘管形成最常见的受累器官包括胃、十二指肠和胆道，其中胃和十二指肠的瘘道发生率较高。此外，合并瘘管形成可能提示IPMN恶性转变风险高，预后不良。对于伴有瘘管形成的IPMN患者，手术干预是一种重要的治疗策略。一些研究指出，对于主胰管型IPMN，尤其是伴有浸润癌的情况，应积极手术治疗，如全胰腺切除术，以实现完全切除。总的来说，IPMN伴瘘管形成的病例具有一定的临床挑战性，需要综合考虑患者的年龄、肿瘤特征以及手术风险等因素，以制定最佳的治疗方案。本文拟从发病机制、诊断及治疗方面对IPMN合并瘘管形成展开叙述，以期提高临床医生对其的认识，更好地指导临床实践，并为患者的诊断和治疗提供更有效的支持。
In patients with intraductal papillary mucinous neoplasm (IPMN), the formation of fistulas is a rare but significant complication. Studies have shown that IPMNs can form fistulas through mechanisms such as mechanical penetration or autolysis, leading to extension into adjacent organs. The most commonly affected organs by fistula formation include the stomach, duodenum, and biliary tract, with the incidence being higher in the stomach and duodenum. Additionally, the presence of a fistula may indicate a high risk of malignant transformation of IPMN and a poor prognosis. For patients with IPMN complicated by fistulas, surgical intervention is an important treatment strategy. Some research suggests that for main pancreatic duct type IPMN, especially when associated with invasive cancer, active surgical treatment such as total pancreatectomy should be considered to achieve complete resection. Overall, cases of IPMN with fistula formation present certain clinical challenges and require comprehensive consideration of patient age, tumor characteristics, and surgical risks to formulate the best treatment plan. This article aims to discuss the pathogenesis, diagnosis, and treatment of IPMN with fistula formation, in hopes of increasing clinicians’ understanding of the condition, better guiding clinical practice, and providing more effective support for patient diagnosis and treatment.
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