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Chinese guidelines for the diagnosis and treatment of pancrestic cystic neoplasm(2022)
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摘要: 随着医学影像技术的发展，胰腺囊性肿瘤(PCN)的检出率逐年增加。PCN包含多种类型，不同类型的PCN生物学特性和恶变风险均有显著差异。由于目前国内缺乏相应指南或共识，导致PCN临床诊断标准不一、缺乏规范的问题较为突出。本指南结合国内外研究进展，基于PCN临床症状、影像或内镜诊断以及随访策略等问题，共提出17条推荐意见，旨在规范我国PCN诊断决策和监测随访流程，促进多学科整合，进一步提升该病的规范化诊断与治疗水平。
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Key words:
- Pancreatic Cystic Neoplasm /
- Diagnosis /
- Image /
- Endoscopic Ultrasound /
- Monitoring
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图 1 胰腺囊性肿瘤诊断随访流程图
Figure 1. Diagnosis and follow-up flow chart of pancreatic cystic tumor
表 1 中国胰腺囊性肿瘤诊断临床问题及推荐意见
Table 1. Clinical problems and recommendations for diagnosis of pancreatic cystic tumors in China
临床问题 推荐意见 PCN会引起临床症状吗？ 大多数PCN无症状，需谨慎地将症状归结于PCN所致。 何种影像学检查可用于诊断PCN？ MRI检查是诊断PCN的首选方法。 EUS是否应用于所有PCN的患者？ 影像学如提示存在病灶最大径＞3 cm、壁结节＞5 mm、囊壁增厚或强化、主胰管扩张＞5 mm、胰管截断伴远侧胰腺萎缩、淋巴结肿大、CA19-9升高、病灶增长速度≥5 mm/2年等征象，建议行EUS进一步评估。EUS联合其他影像学检查可提高PCN的诊断准确度。 EUS-FNA/FNB的适应证是什么？ 对于影像学检查不能确定性质的PCN或EUS-FNA/FNB可能改变治疗策略时，建议行EUS-FNA/FNB。 应选择哪些囊液检测方法对胰腺囊性病灶进行鉴别诊断？ 囊液分析如拉丝试验、细胞学、淀粉酶、CEA、葡萄糖检测及KRAS/GNAS基因突变分析可用于鉴别PCN类型。 EUS-TTNB相比EUS-FNA是否能够提高PCN的诊断效能？ EUS-TTNB相比EUS-FNA能显著提高PCN的诊断效能，同时EUS-TTNB不良事件发生率较低。 应在何种情况下考虑将nCLE应用于PCN患者？ nCLE应使用于拟行手术治疗而无法排除SCN的PCN患者。 CE-EUS是否可用于评估PCN的性质？ CE-EUS可显示病变血供，建议使用CE-EUS进一步评估壁结节，亦有助于评估囊内血管和分隔。CE-EUS上出现壁结节、实性肿块或分隔的过度强化，需警惕病变恶变可能，应考虑对病变处进行EUS-FNA。 MD-IPMN或MT-IPMN是否需行胰管镜检查？ 合并高危征象或临床难以鉴别的MD-IPMN或MT-IPMN推荐行胰管镜检查。 何类PCN患者应列为随访对象？ 诊断考虑为MCN或IPMN的无症状性PCN且具备手术条件的患者应列为随访对象。恶变风险极低的SCN患者建议根据症状进行随访。 何种检查方法为PCN随访人群的最佳选择？ 推荐MRI联合MRCP作为IPMN或MCN的随访检查方法。EUS或CT可作为存在MRI禁忌患者的随访检查方法。 PCN患者的最佳随访周期是多久？ 推荐无高危征象的IPMN或MCN可根据病灶大小制定监测随访策略。含高危征象的IPMN或MCN经多学科会诊(multi-disciplinary treatment，MDT)后未行手术者建议间隔6月进行MRI随访。 注：PCN为胰腺囊性肿瘤；MRI为核磁共振；EUS为超声内镜；EUS-FNA/FNB为超声内镜引导下细针穿刺活检；EUS-TTNB为超声内镜引导经穿刺针活检钳活检术；nCLE为细针型共聚焦激光显微内镜；CE-EUS为对比增强EUS；MD-IPMN为主胰管型胰腺导管内乳头状黏液性肿瘤；MT-IPMN为混合型胰腺导管内乳头状黏液性肿瘤；MCN为黏液性囊腺瘤；SCN为浆液性囊腺瘤；MRCP为磁共振胰胆管造影；CT为电子计算机断层扫描。 
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