The Research Of Clinical Diagnosis And Treatment Of Intraductal Papillary Mucinous Neoplasms Of Pancreas

Objective:There are still some controversies on diagnosis, classification, surgical indications and surgical approach of pancreas intraductal papillary mucinous neoplasm (IPMN).In this article, we collected and summarized IPMN cases and shared the experience about clinical diagnosis and therapy of IPMN.Methods:From August 2013 to March 2016, twenty-two patients with intraductal papillary mucinous neoplasm (IPMN) were retrospectively analysed, including general data, clinical feature, imageology, surgical procedures, frozen section, postoperative pathology and follow-up results.Results Of all 22 patients,11 were male and 11 were female.The median age was 68.2 year-old with age ranged from 54 to 88 year-old.9 patients had clinical feature such as abdominal pain, nausea, vomiting, fatigue, fever and so on.4 patients had elevated serum amylase. Totally 16 cases accepted B ultrasound while 19 cases accepted CT scan and 20 cases accepted MR. According to imageology,1 case was classified as main duct IPMN(MD-IPMN),17 cases were classified as branch duct IPMN(BD-IPMN) and 4 cases were classified as mixed type.6 cases had an MPD diameter of 5-9 mm and 16 cases had an MPD diameter of< 5 mm.6 cases had an pancreatic cyst of ≥3 cm and 16 cases had an pancreatic cyst of <3 cm.13 cases had single lesion and 8 cases had multiple lesions while 1 case without obvious lesion. That in single cyst 5 cases located in the head,3 cases located in the neck,2 cases located in uncinate pancreas while another 3 were in the body of pancreas. Conservative treatment for 6 cases (27.27%) and surgical therapy for other cases (72.73%).12 cases underwent pancreaticoduodenectomy and central pancreatectomy in 3 while 1 underwent distal pancreatectomy.13 case were diagnosed IPMN,2 was MCN,1 was SCN with the accuracy of was 81.25%(13/16).14 cases had monitored amylase of drain and 7 cases had pancreatic leakage.20 cases had follow-up with the rate of 90.91% (20/22).Only 1 patient was dead and the rest were alive till now without recurrence.Conclusion:The clinical diagnosis of IPMN is mainly based on imageology. Combined diagnosis of CT, MRI and MRCP is more accuracy. Classification is important for treatment. MD-IPMN and mixed type without contraindication should be resected. The treatment of BD-IPMN should be based on tumor size, wall nodular and wall strengthening. The approach is based on classification, the location and number of cysts. Intraoperative frozen is necessary. The management of postoperative complications and prognosis need more studies.