威胁 PJS 患者生命的主要并发症是肿瘤和小肠梗阻。两项小规模研究发现 PJS 患者比他们的未患病家族成员去世的更早,原因是梗阻或癌症。[35]Westerman AM, Entius MM, de Baar E, et al. Peutz-Jeghers syndrome: 78 year follow up of the original family. Lancet. 1999 Apr 10;353(9160):1211-5.http://www.ncbi.nlm.nih.gov/pubmed/10217080?tool=bestpractice.com[36]Spigelman AD, Murday V, Phillips RK. Cancer and the Peutz-Jeghers syndrome. Gut. 1989 Nov;30(11):1588-90.http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1434341&blobtype=pdfhttp://www.ncbi.nlm.nih.gov/pubmed/2599445?tool=bestpractice.com
可以明确的是小肠梗阻是导致手术的主要原因之一,可以通过切除小肠息肉尽可能避免手术。[12]Spigelman AD, Thomson JP, Phillips RK. Towards decreasing the relaparotomy rate in the Peutz-Jeghers syndrome: the role of peroperative small bowel endoscopy. Br J Surg. 1990 Mar;77(3):301-2.http://www.ncbi.nlm.nih.gov/pubmed/2322793?tool=bestpractice.com[22]Oncel M, Remzi FH, Church JM, et al. Benefits of "clean sweep" in Peutz-Jegher's patients. Colorectal Dis. 2004 Sep;6(5):332-5.http://www.ncbi.nlm.nih.gov/pubmed/15335366?tool=bestpractice.com[23]Pennazio M, Rossini FP. Small bowel polyps in Peutz-Jeghers syndrome: management by combined push enteroscopy and intraoperative enteroscopy. Gastrointest Endosc. 2000 Mar;51(3):304-8.http://www.ncbi.nlm.nih.gov/pubmed/10699775?tool=bestpractice.com[24]Edwards DP, Khosraviani K, Stafferton R, et al. Long-term results of polyp clearance by intraoperative enteroscopy in the Peutz-Jeghers syndrome. Dis Colon Rectum. 2003 Jan;46(1):48-50.http://www.ncbi.nlm.nih.gov/pubmed/12544521?tool=bestpractice.com[25]Lin BC, Lien JM, Chen RJ, et al. Combined endoscopic and surgical treatment for the polyposis of Peutz-Jeghers syndrome. Surg Endosc. 2000 Dec;14(12):1185-7.http://www.ncbi.nlm.nih.gov/pubmed/11148795?tool=bestpractice.com[26]Zanoni EC, Averbach M, Borges JL, et al. Laparoscopic treatment of intestinal intussusception in the Peutz-Jeghers syndrome: case report and review of the literature. Surg Laparosc Endosc Percutan Tech. 2003 Aug;13(4):280-2.http://www.ncbi.nlm.nih.gov/pubmed/12960794?tool=bestpractice.com 研究发现与普通人群相比,PJS患者终身发生肠道和肠外恶性肿瘤的风险更高;累计终身风险可达93%。[1]Giardiello FM, Bresinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000 Dec;119(6):1447-53.http://www.ncbi.nlm.nih.gov/pubmed/11113065?tool=bestpractice.com 报道称患者发生肿瘤的中位年龄在40-50岁。特异性肿瘤的终身风险分别为乳腺癌(50%)、胰腺癌(36%)、卵巢癌(21%)、非小细胞肺癌(15%)、宫颈癌(10%)和子宫癌(9%)。[1]Giardiello FM, Bresinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000 Dec;119(6):1447-53.http://www.ncbi.nlm.nih.gov/pubmed/11113065?tool=bestpractice.com 男性儿童和青少年,以及少量青年男性,也存在发生睾丸癌的风险。[1]Giardiello FM, Bresinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000 Dec;119(6):1447-53.http://www.ncbi.nlm.nih.gov/pubmed/11113065?tool=bestpractice.com 然而,支持肿瘤发病率,尤其是死亡率数据的证据非常有限,只能从少量的观察到的个体和家庭中获得。[1]Giardiello FM, Bresinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000 Dec;119(6):1447-53.http://www.ncbi.nlm.nih.gov/pubmed/11113065?tool=bestpractice.com 虽然推荐监测,但是监测对于早期发现或者预防肿瘤是否有效,目前还不明确。[37]Dunlop MG. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz-Jeghers syndrome. Gut. 2002 Oct;51(suppl 5):V21-7.http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1867741&blobtype=pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12221036?tool=bestpractice.com