本文選題：導(dǎo)管內(nèi)乳頭狀黏液腫瘤 + 非侵入性IPMN��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:IPMN被認(rèn)為是處于胰腺的液性囊腫。在近幾十年中,此疾病發(fā)生率增長相當(dāng)大,且發(fā)展成侵入性IPMN的潛在性也在增加。惡性腫瘤的術(shù)前診斷和成功切除仍是懸而未決。切除術(shù)后長期生存率和最小復(fù)發(fā)的結(jié)果是沖突的。此研究目的在于從發(fā)病率、人口統(tǒng)計(jì)、最易發(fā)生的癥狀、兩種亞型中腫瘤位置、非侵入性和侵入性IPMN的病理學(xué)及組織病理學(xué)、兩種亞型中最常用的胰腺切除術(shù)、最易發(fā)生的術(shù)后并發(fā)癥等幾方面比較兩種不同IPMN亞型(非侵入性和侵入性)。然而,主要目的是比較非侵入性IPMN和侵入性IPMN的5年存活率和5年復(fù)發(fā)率。也比較由于復(fù)發(fā)或其他原因的死亡率之間的區(qū)別。方法:因特網(wǎng)篩選包含特別關(guān)注非侵入性和侵入性IPMN兩種亞型中存活及復(fù)發(fā)信息的文章。恰當(dāng)?shù)男畔⒈缓Y選出來用于支持此比較研究的寫作和細(xì)化,最后,源自于世界各地的11名IPMN領(lǐng)域的作者的作品被選中為此研究貢獻(xiàn)數(shù)據(jù)。這些研究中的8部用來比較存活率,9部用于區(qū)別非侵入性IPMN和侵入性IPMN的復(fù)發(fā)率。畫了一系列的森林圖來展示研究參數(shù)之間的區(qū)別。由圖表生成的數(shù)據(jù)和11部研究提供的原始數(shù)據(jù)分析一起,用于比較此研究的產(chǎn)出。來自于考克蘭圖書館的循證醫(yī)學(xué)(Revman5.3)用作統(tǒng)計(jì)分析軟件。結(jié)果:非侵入性IPMN和侵入性IPMN的發(fā)生率偏向于非侵入性IPMN(讓步比3.41,95%CI:2.94-3.97,p0.00001),IPMN 的發(fā)生在年齡 60～70 歲,男女比例為 1:1.腹部疼痛是患有IPMN的病人最常見的癥狀。在非侵入性IPMN中胰頭是原位癌最常產(chǎn)生的位置,而侵入性IPMN常是管狀。惠普爾手術(shù)是針對IPMN最常用的切除術(shù),瘺是最常見的術(shù)后并發(fā)癥。非侵入性IPMN中存活率和死亡率偏向于存活率(讓步比 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(讓步比1.57,95%CI:1.14-2.16,p=0.006)。非侵入性IPMN的存活率與侵入性IPMN的存活率偏向于非侵入性IPMN(讓步比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的復(fù)發(fā)與非復(fù)發(fā)比例偏向于非復(fù)發(fā)(讓步比0.00,95%CI:0.00-0.01,p0.00001)。侵入性IPMN的復(fù)發(fā)與非復(fù)發(fā)比例偏向于非復(fù)發(fā)(讓步比0.24,95%CI:0.18-0.33,p0.00001)。非侵入性IPMN的復(fù)發(fā)和侵入性IPMN的復(fù)發(fā)比例比較,偏向于侵入性 IPMN 的復(fù)發(fā)(讓步比 0.09,95%CI:0.06-0.15,p0.00001)。IPMN 五年以上復(fù)發(fā)率是19%。由于非侵入性和侵入性IPMN復(fù)發(fā)導(dǎo)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復(fù)發(fā)導(dǎo)致的死亡(讓步比4.22,95%CI:2.22-8.03,p0.0001)。結(jié)論:基于本研究的發(fā)現(xiàn),被診斷為侵入性和非侵入性IPMN的病患,大部分年齡在60-70歲,發(fā)病幾率為男女比例1:1.然而在亞洲國家稍偏向于男性,在美國和歐洲人中較偏向于女性。我們也注意到,被診斷為IPMN的病患大部分就醫(yī)時(shí)腹部疼痛是其主要癥狀,也有很多病人有些時(shí)候是沒有癥狀的。因此很多無證狀的病患,偶然地被診斷為IPMN。胰頭似乎是最常患有IPMN的位置。依據(jù)病理學(xué)觀點(diǎn),結(jié)果顯示非侵入性IPMN的發(fā)生幾率高于侵入性IPMN,這讓患有非侵入性IPMN的患者有更好的預(yù)后。然而,結(jié)果顯示非侵入性IPMN患者原位癌的發(fā)生比率高于腺瘤和邊緣瘤,這也許能解釋為什么非侵入性IPMN仍然會復(fù)發(fā)。在侵入性IPMN中,管狀是最常產(chǎn)生的�；萜諣柺中g(shù)法,不管是常規(guī)程序還是稍微修改的手術(shù)程序,都最常被用于IPMN胰腺切除術(shù)。新輔助/輔助治療作為IPMN的治療措施是具有不確定性的,且需要更多的研究。關(guān)于圍術(shù)期并發(fā)癥術(shù)后切除,已經(jīng)得出結(jié)論,瘺是除胃排空延遲和腹腔積液外發(fā)生率最高的。非侵入性患者的五年生存率完全超過侵入性患者的存活率,且非侵入性IPMN患者復(fù)發(fā)率高于非侵入性患者。由于IPMN復(fù)發(fā)引起的死亡率與由于其他原因引起的死亡率的對比結(jié)果顯示,很多病人由于胰腺治療切除術(shù)后復(fù)發(fā)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.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.9

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