Clinical Analysis Of Intraductal Papillary Mucinous Neoplasm Of The Pancreas

Objective:To study the clinical diagnosis and treatment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods:Collect and study the materials of 14 patients whom were checked in the First Affiliated Hospital of Zhejiang University from January 2009 to January 2011 with intraductal papillary mucinous neoplasm (IPMN) of pancreas in pathological diagnosis. Then analyze the diagnosis and treatment of IPMN.Results:Age of onset was 62.3±6.7. The ratio of men to women was 3.67:1. The main clinical symptoms of the 14 cases were abdominal pain(78.4%), weight loss(21.4%), jaundice(14.3%), nausea and vomiting(14.3%), diarrhea(7.1%), and so on. At the same time, three cases(21.4%) were combined with pancreatitis, when four cases(28.6%) combined with diabetes. Nine cases (64.3%) displayed cystic or solid mass in Ultrasonography, CT, or MPCP, while all patients had varying degrees of pancreatic ductal dilatation. Three patients(21.4%) had ERCP examination, with which we saw the augmentation of carunculae major, dilated pancreatic ducts and muscus effusing out of duodenal papilla. Pathological diagnosis after operations showed that there were 5 IPMN adenoma (35.7%),6 borderline IPMN (42.8%),1 IPMN with carcinoma in situ(7.1%) and 2 IPMN with invasive carcinoma (14.3%). All patients had operations. Three patients received total pancreatectomy and splenectomy, two of which were invasive carcinoma, while 6 cases received routine pancreaticoduodenectomy,2 cases received pancreatic tail excision and splenectomy,2 cases received pancreatic resection of pancreatic neck section and 1 cases received local pancreas excision. After operations, pancreatic fistula hanppened in 5 cases, while bile leakage in 1 case, delayed gastric emptying in 2 cases, postoperative bleeding in 1 case, abdominal infection in 1 case, urinary retention in 1 case, lymph fistula in 1 case and insulin replacement therapy in 3 cases. After supportive treatments, all of them cured. So far 14 people survived and were followed up with no signs of tumor recurrence.Conclusions:IPMN of the pancreas is a disease of the ductal epithelium with characteristic pathological features and represent a spectrum of disease, ranging from benign to malignant lesions. It mainly occurred in old men and there was no-specific clinical feature and laboratory examination. Image examinations were the main diagnostic method at present. Surgical resection was the first treatment to cure IPMN with good prognosis.