췌장의 낭종성 질환-수술 혹은 경과관찰
Pancreatic cystic lesion-Surgery or follow-up evaluation
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췌장의 낭종성 병변들 중에서 악성화 위험도가 있는 전암성 병변인 점액성 낭성종양과 췌관 내 유두상 점액성 종양중 주췌관형은 수술적 치료가 원칙이며, 분지형 췌관 내 유두상 점액성 종양은 악성화 위험이 있기는 하나 비교적 악성화 위험도가 낮고 진행이 느린 것으로 알려져 있어 크기가 3 cm 이상이거나 벽결절이 관찰되거나 증상이 발현된 경우에 수술적 치료를 고려한다. 고형 가성 유두상 종양 또한악성화 위험도가 있으므로 수술적 절제가 원칙이다. 장액성낭성종양은 악성화 위험도가 매우 낮으므로 전형적인 경우에는 경과를 관찰하는 것으로 충분하다. 가성낭종의 경우에는 출혈, 감염, 통증 등이 비수술적 치료로 조절이 되지 않을경우에 수술을 고려하여야 한다. 개개의 환자에서 수술적 치료에 대한 결정은 병변의 악성화 위험도 외에도 증상의 유무, 환자의 연령, 낭종의 크기, 낭종의 위치, 수술 위험도 등을 함께 고려하여야 한다. 췌장의 낭종성 병변의 경과관찰에 대한 검사 종류와 검사간격은 정립되어 있지 않으나 6~12개월 간격으로 복부 전산화단층촬영 검사나 복부 자기공명영상 검사 시행이 주로 권유되며, 병변의 크기와 위치 등과 함께 환자의 연령, 전신상태, 수술위험성 등을 고려하여 적절한 검사 종류와 검사 간격을 결정하여야 한다.
Abstract
The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient.
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