中西医诊治胰腺导管内乳头状黏液性肿瘤研究进展

Research Progress in Diagnosis and Treatment of Intraductal Papillary Mucinous Neoplasm of the Pancreas by Integrated Traditional Chinese and Western Medicine

摘要: 胰腺导管内乳头状黏液性肿瘤是起源于胰腺导管上皮的囊性肿瘤，以分泌黏液为特征，具有潜在恶变风险。西医的诊治主要以影像学评估、病理分型及手术指征判断为核心，但对于良性或者交界性病变的随访管理、术后并发症防治及抗肿瘤复发等方面仍存在局限性。中医理论将其归属于“积聚”“痞满”等范畴，认为其病机与脾胃虚弱、湿浊瘀毒互结相关。中西医结合诊治胰腺导管内乳头状黏液性肿瘤各有优势又互为补充，将两者充分结合可使IPMN患者受到最大获益。但是目前中西医结合诊治IPMN策略尚未完善。本综述系统梳理了IPMN的西医诊断体系、风险评估及治疗手段，并结合中医理论中的病因病机及治法，从中西医结合角度总结影像、内镜、分子诊断、生物学标志物诊断的优缺点，手术、消融、内镜治疗与中医辨证论治的研究进展，体现中西医结合诊治胰腺导管内乳头状肿瘤的特色优势，概括其诊治IPMN的临床思路。

Abstract: Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas is a cystic neoplasm originating from pancreatic ductal epithelium, characterized by mucin secretion and potential malignant transformation. Western medicine diagnosis and treatment mainly focus on imaging evaluation, pathological classification, and judgment of surgical indications, but there are limitations in follow-up management of borderline lesions, prevention and treatment of postoperative complications, and anti-tumor recurrence. In Traditional Chinese Medicine (TCM) theory, IPMN is classified into the categories of “Ji Ju” (abdominal mass) and “Pi Man” (epigastric fullness), with its pathogenesis related to spleen-stomach deficiency and intermingling of dampness-turbidity, blood stasis, and toxin. Diagnosis and treatment of IPMN by integrated traditional Chinese and Western medicine have respective advantages and complement each other, and their full combination can maximize benefits for IPMN patients. However, the strategy of integrating traditional Chinese and Western medicine for IPMN has not yet been perfected. This review systematically combs the diagnostic system, risk assessment, and treatment modalities of IPMN in Western medicine, combines with the etiology, pathogenesis, and therapeutic methods in TCM theory, summarizes the advantages and disadvantages of imaging, endoscopic, molecular diagnostic, and biomarker diagnostic methods from the perspective of integrated medicine, and reviews the research progress of surgery, ablation, endoscopic treatment combined with TCM syndrome differentiation and treatment, so as to reflect the characteristic advantages of integrated traditional Chinese and Western medicine in diagnosing and treating IPMN, and outline its clinical thinking for IPMN management.