侵袭性和非侵袭导管内乳头状粘液肿瘤的临床研究

发布时间：2018-04-27 13:40

本文选题：导管内乳头状黏液肿瘤 + 非侵入性IPMN　；参考：《浙江大学》2017年硕士论文

【摘要】：背景:IPMN被认为是处于胰腺的液性囊肿。在近几十年中,此疾病发生率增长相当大,且发展成侵入性IPMN的潜在性也在增加。恶性肿瘤的术前诊断和成功切除仍是悬而未决。切除术后长期生存率和最小复发的结果是冲突的。此研究目的在于从发病率、人口统计、最易发生的症状、两种亚型中肿瘤位置、非侵入性和侵入性IPMN的病理学及组织病理学、两种亚型中最常用的胰腺切除术、最易发生的术后并发症等几方面比较两种不同IPMN亚型(非侵入性和侵入性)。然而,主要目的是比较非侵入性IPMN和侵入性IPMN的5年存活率和5年复发率。也比较由于复发或其他原因的死亡率之间的区别。方法:因特网筛选包含特别关注非侵入性和侵入性IPMN两种亚型中存活及复发信息的文章。恰当的信息被筛选出来用于支持此比较研究的写作和细化,最后,源自于世界各地的11名IPMN领域的作者的作品被选中为此研究贡献数据。这些研究中的8部用来比较存活率,9部用于区别非侵入性IPMN和侵入性IPMN的复发率。画了一系列的森林图来展示研究参数之间的区别。由图表生成的数据和11部研究提供的原始数据分析一起,用于比较此研究的产出。来自于考克兰图书馆的循证医学(Revman5.3)用作统计分析软件。结果:非侵入性IPMN和侵入性IPMN的发生率偏向于非侵入性IPMN(让步比3.41,95%CI:2.94-3.97,p0.00001),IPMN 的发生在年龄 60～70 岁,男女比例为 1:1.腹部疼痛是患有IPMN的病人最常见的症状。在非侵入性IPMN中胰头是原位癌最常产生的位置,而侵入性IPMN常是管状。惠普尔手术是针对IPMN最常用的切除术,瘘是最常见的术后并发症。非侵入性IPMN中存活率和死亡率偏向于存活率(让步比 31.76,95%CI:21.87-46.12,p0.00001)),侵入性 IPMN 的存活率和死亡率偏向于存活率(让步比1.57,95%CI:1.14-2.16,p=0.006)。非侵入性IPMN的存活率与侵入性IPMN的存活率偏向于非侵入性IPMN(让步比6.36,95%CI:4.22-9.61,p0.00001),IPMN五年以上存活率是74%。非侵入性IPMN的复发与非复发比例偏向于非复发(让步比0.00,95%CI:0.00-0.01,p0.00001)。侵入性IPMN的复发与非复发比例偏向于非复发(让步比0.24,95%CI:0.18-0.33,p0.00001)。非侵入性IPMN的复发和侵入性IPMN的复发比例比较,偏向于侵入性 IPMN 的复发(让步比 0.09,95%CI:0.06-0.15,p0.00001)。IPMN 五年以上复发率是19%。由于非侵入性和侵入性IPMN复发导致的死亡和由于其他原因造成的死亡相比,偏向于非侵入性和侵入性IPMN复发导致的死亡(让步比4.22,95%CI:2.22-8.03,p0.0001)。结论:基于本研究的发现,被诊断为侵入性和非侵入性IPMN的病患,大部分年龄在60-70岁,发病几率为男女比例1:1.然而在亚洲国家稍偏向于男性,在美国和欧洲人中较偏向于女性。我们也注意到,被诊断为IPMN的病患大部分就医时腹部疼痛是其主要症状,也有很多病人有些时候是没有症状的。因此很多无证状的病患,偶然地被诊断为IPMN。胰头似乎是最常患有IPMN的位置。依据病理学观点,结果显示非侵入性IPMN的发生几率高于侵入性IPMN,这让患有非侵入性IPMN的患者有更好的预后。然而,结果显示非侵入性IPMN患者原位癌的发生比率高于腺瘤和边缘瘤,这也许能解释为什么非侵入性IPMN仍然会复发。在侵入性IPMN中,管状是最常产生的。惠普尔手术法,不管是常规程序还是稍微修改的手术程序,都最常被用于IPMN胰腺切除术。新辅助/辅助治疗作为IPMN的治疗措施是具有不确定性的,且需要更多的研究。关于围术期并发症术后切除,已经得出结论,瘘是除胃排空延迟和腹腔积液外发生率最高的。非侵入性患者的五年生存率完全超过侵入性患者的存活率,且非侵入性IPMN患者复发率高于非侵入性患者。由于IPMN复发引起的死亡率与由于其他原因引起的死亡率的对比结果显示,很多病人由于胰腺治疗切除术后复发死亡,而不是其他原因。
[Abstract]:Background: IPMN is considered a liquid cyst in the pancreas. The incidence of this disease has increased considerably in the last few decades, and the potential for developing invasive IPMN is also increasing. The preoperative diagnosis and successful resection of malignant tumors are still in pending. The long-term survival rate after resection is in conflict with the results of the smallest recurrence. The aim of this study is to study the objective of this study. From the incidence, demography, the most likely symptoms, the two subtypes of tumor location, the pathological and histopathology of non invasive and invasive IPMN, the most commonly used pancreatectomy in the two subtypes, the most likely postoperative complications, and other two different IPMN subtypes (non invasive and invasive). However, the main purpose is It is the 5 year and 5 year recurrence rates of comparative non invasive IPMN and invasive IPMN. The difference between recurrence and other causes is also compared. Method: Internet screening includes articles on survival and recurrence in two subtypes of non invasive and invasive IPMN. Appropriate information is screened to support this The writing and refinement of the comparative study, finally, the works of 11 IPMN authors from all over the world were selected for this research contribution data. 8 of these studies were used to compare the survival rates, and 9 used to distinguish the recurrence rates of non invasive IPMN and invasive IPMN. The data generated by the chart and the original data analysis provided by the 11 studies are used to compare the output of this study. The evidence based medicine (Revman5.3) from the coland library is used as a statistical analysis software. Results: the incidence of non invasive IPMN and invasive IPMN is biased towards non invasive IPMN (3.41,95%CI:2.94-3.97, p0.00001), I The occurrence of PMN is 60~70 years old, and the proportion of men and women with 1:1. abdominal pain is the most common symptom in patients with IPMN. The head of the pancreas is the most common location in non invasive IPMN, while invasive IPMN is often the tube. The Whipple operation is the most common resection of IPMN, the most common postoperative complication. Noninvasive IPMN The survival rates and mortality rates were biased toward survival (31.76,95%CI:21.87-46.12, p0.00001), and the survival and mortality of invasive IPMN were biased toward survival (1.57,95%CI:1.14-2.16, p=0.006). The survival of non invasive IPMN and the survival of invasive IPMN were biased towards non invasive IPMN (P0, 6.36,95%CI:4.22-9.61, P0). .00001), the survival rate over five years for IPMN is the recurrence and non recurrence ratio of 74%. non invasive IPMN to non recurrence (concession ratio 0.00,95%CI:0.00-0.01, p0.00001). The recurrence and non recurrence ratio of invasive IPMN is biased toward non recurrence (concession ratio 0.24,95%CI:0.18-0.33, p0.00001). The recurrence of non invasive IPMN and the recurrence rate of invasive IPMN are proportional to the recurrence rate of non invasive IPMN. In comparison, the recurrence rate for the recurrence of invasive IPMN (concession ratio 0.09,95%CI:0.06-0.15, p0.00001).IPMN over five years is the death caused by 19%. due to non invasive and invasive IPMN recurrence and death due to other causes, which is biased towards the death of non invasive and invasive IPMN recurrence (concession ratio 4.22,95%CI:2.22-8.). 03, P0.0001) conclusion: Based on the findings of this study, patients diagnosed with invasive and noninvasive IPMN were most aged at the age of 60-70, with a ratio of 1:1. to male and female in Asian countries, while in the United States and Europeans, we also noted that most of the patients diagnosed as IPMN were hospitalized. Abdominal pain is the main symptom, and many patients are sometimes asymptomatic. So many undocumented patients, incidentally diagnosed with the IPMN. head, seem to be the most often IPMN. According to the pathological view, the incidence of non invasive IPMN is higher than that of invasive IPMN, which makes the patients suffering from non invasive IPMN. There is a better prognosis. However, the results show that the incidence of carcinoma in situ in non invasive IPMN patients is higher than that of the adenoma and marginal tumor, which may explain why non invasive IPMN still recurs. In invasive IPMN, the tube is the most common. The Whipple procedure, whether a regular procedure or a slightly modified procedure, is the most common. It is used for IPMN pancreatectomy. Neoadjuvant / adjuvant therapy as a treatment for IPMN is uncertain and needs more research. For postoperative complications after perioperative complications, it has been concluded that the fistula is the highest rate in addition to delayed gastric emptying and effusion. The five year survival rate of non invasive patients is completely beyond the invasion. The survival rate of the patients with sex, and the recurrence rate of non invasive IPMN patients was higher than that of non invasive patients. The comparison of mortality caused by IPMN recurrence and the mortality caused by other causes showed that many patients died of recurrence after resection of the pancreas, not other causes.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9

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