胆管导管内乳头状黏液性肿瘤的研究现状

徐颖; 唐加; 何清云; 吴会超

doi:10.3969/j.issn.1001-5256.2021.12.052

胆管导管内乳头状黏液性肿瘤的研究现状

DOI: 10.3969/j.issn.1001-5256.2021.12.052

遵义医科大学附属医院消化内科，遵义 563000

基金项目:

贵州省科学技术基金项目 (J LKZ〔2013〕13 of Guizhou Science and Technology Cooperation)

详细信息

通信作者:
吴会超，wuhuichao_gzzy@aliyun.com

中图分类号: R735.8
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-25
- 录用日期: 2021-07-01
- 出版日期: 2021-12-20

Research advances in intraductal papillary mucinous neoplasm of the bile tract

Department of Gastroenterology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China

Research funding:

Science and Technology Foundation Project of Guizhou Province (J LKZ〔2013〕13 of Guizhou Science and Technology Cooperation)

摘要

摘要: 胆管导管内乳头状黏液性肿瘤(IPMN-B)是发生在胆管系统的一类特殊肿瘤，其临床表现及影像学均无特异性，术前诊断困难，往往于术中发现胆管内充盈大量黏液时考虑本病而被迫临时改变手术方案。由于其发病率低，临床医师对其缺乏认识。综述了近年来IPMN-B的病因与分型、临床特征、鉴别诊断、治疗及预后等方面研究进展，以期提高临床医师对IPMN-B的诊疗水平。
- 胆管肿瘤 /
- 治疗学 /
- 预后
Abstract: Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a special type of tumor occurring in the biliary system, with no specific clinical manifestations and imaging findings, and thus it is difficult to diagnose before surgery. It is often considered when a large amount of mucus is found in the bile duct during surgery and then it is forced to change the surgical plan. Clinicians lack an understanding of this disease due to its low incidence rate. This article reviews the recent research advances in the etiology and classification, clinical features, differential diagnosis, treatment, and prognosis of IPMN-B, so as to improve the clinical diagnosis and treatment of IPMN-B among clinicians.
- Bile Duct Neoplasms /
- Therapeutics /
- Prognosis

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图 1 腹部检查

注：a，典型的CT表现为肝内胆管明显的囊性扩张，右肝叶胆管有一小点状高密度病变；b，T2磁共振成像显示肝内胆管明显呈“软藤状”扩张，胆管内有小结节T2信号灶；c，十二指肠镜检查显示乳头上方有一个直径为1.0 cm的十二指肠瘘，内部充满了胶状黏液。

下载: 全尺寸图片幻灯片

图 2 ERCP检查

注：十二指肠乳头开口处呈“鱼眼征”，并伴有黏液流出。

下载: 全尺寸图片幻灯片

表 1 IPMN-B的免疫组化分型

分型	MUC1	MUC2	MUC5AC	MUC6
肠型	-	+	+	-
胃型	-	-	+	+
胰胆管型	+	-	+	-
嗜酸性细胞型	+	-	+	+

下载: 导出CSV

表 2 IPMN-B的影像学分型

分型	特征
典型IPMN-B	胆管内肿瘤灶和肿瘤上、下游胆管均明显扩张
囊性IPMN-B	胆管呈局限性囊状扩张，表现为囊性肿块，囊内可见瘤灶，可单发或多发
无肿块型IPMN-B	肝内外胆管均明显扩张，未见明显瘤灶和囊性肿块
侵袭型IPMN-B	瘤体不仅向腔内乳头状生长而且突破胆管壁向外浸润胆管周围组织

下载: 导出CSV

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