以急性胰腺炎为首发表现的胰腺癌——附21例分析

目的 探讨以急性胰腺炎（AP）为首发表现的胰腺癌的诊断和治疗。方法 对从1996-2006年问部分国内期刊所报道的19例患者及本科诊治的2例患者在病因、临床表现、诊断及治疗等方面进行回顾性分析。结果 21例患者人院时均有典型AP的症状、体征和实验室检查，CA19—9正常或升高，CT、ERCP等均提示胰腺肿大，部分患者伴胰管扩张及胆囊结石和胆管扩张．人院时均诊断为AP，外院19例诊断为胰腺癌时已错过根治性手术时机，本院1例及时修正诊断后行根治性手术，预后良好，另一例术中明确诊断后已失去根冶机会。结论 对AP均需综合病史、CA19-9和影像学资料排除胰腺癌，才能对此类特殊病例及时诊断、果断手术以取得满意疗效。

Acute pancreatitis as an initial finding of pancreatic cancer: analysis of 21 clinical cases

Objective To discuss the diagnosis and treatment of pancreatic cancer (PC) with acute pancreatitis (AP) as the initial finding. Methods Included in this study were 19 PC patients reported in the literature in China and two PC patients admitted in Gulou Hospital from 1996 to 2006. Medical data of these patients were reviewed retrospectively in terms of etiology, clinical presentation, diagnosis and treatment. Results 21 patients had typical AP symptoms and signs and laboratory findings on admission. CA19-9 was within the normal range or elevated. The pancreas was found to be enlarged on CT and ERCP. Some patients were also associated with enlargement of the pancreatic and biliary ducts and cholecystolithiasis. All patients were diagnosed as having AP on admission. The 19 patients in other hospitals had lost the chance of surgical operation at the time of PC diagnosis. One of the patients in this hospital received radical surgery after correction of the diagnosis and survived well, while the other patient had lost the chance of surgical operation at the time of PC diagnosis. Conclusions The diagnosis of pancreatic carcinoma should be excluded in patients with AP by means of history, CA19-9 and imageology, so that timely surgery can be performed and better outcomes achieved.