急性胰腺炎伴胰管扩张MRCP表现及临床意义

目的 分析急性胰腺炎(AP)伴胰管扩张的MRCP表现及临床意义。 方法 分析确诊为AP的51例患者的临床和MRCP表现,比较胰管扩张AP病例(A组)与胰管正常AP病例(B组)的影像学表现差异。MRCP观察项目包括胰管和胆总管(CBD)直径、胰管形态、有无胰胆管结石及胰腺假性囊肿;临床观察项目包括病程及是否为复发(ARP)。 结果 A组21例AP 有胰管扩张 ,其中17例胰管边缘光滑,4例粗细不均;B组30例AP胰管正常 。A组3例伴假性囊肿,B组未见(P<0.05)。A、B两组CBD直径分别为 。A组11例、B组3例见双管征(P<0.01)。A组12例、B组仅6例ARP(P<0.01)。A组平均治疗天数为(24.43±10.63)天,B组为(15.03±5.45)天(P<0.001)。 结论 胰管扩张与非扩张AP的MRCP表现及临床病程存在一定差异,认识这些表现有助于做出正确影像学诊断和合理的临床评价。     

自身免疫性胰腺炎影像学特征1例

自身免疫性胰腺炎（autoimmune pancreatitis,AIP）是一类有自身免疫机制参与的特殊类型胰腺炎,约占慢性胰腺炎患者的7%[1]。AIP多见于60-70岁的男性,主要临床症状包括梗阻性黄疸、轻度腹痛,食欲减退和体重下降,影像学常见胰腺弥漫或局限性肿大,胰管及胆总管下段狭窄。AIP对激素治疗敏感,     

自身免疫性胰腺炎研究进展

自身免疫性胰腺炎是慢性胰腺炎的特殊类型,临床表现为梗阻性黄疸、腹痛、体质量减轻等,易误诊为胰腺癌而行手术治疗。不同地区或国家对免疫性胰腺炎的诊断标准尚未达成一致,提高自身免疫性胰腺炎诊疗水平是国内外研究热点。类固醇类药物治疗自身免疫性胰腺炎效果明显,可改善患者临床症状及预后。     

自身免疫性胰腺炎诊治进展

自身免疫性胰腺炎（AIP）是一种慢性胰腺炎,实验室检查、组织学检查、临床表现均显示与自身免疫有关。此病的特点为球蛋白、IgG4升高,抗Ⅱ碳酸酐酶抗体和抗乳铁蛋白抗体阳性,弥散性肿大的胰腺、显著的淋巴细胞浸润伴随纤维化。临床表现多样,经典的腹部CT表现为胰腺弥散性肿大呈腊肠样,密度均匀,轻微强化,周边低密度囊状缘,对糖皮质激素治疗敏感。该文就AIP目前的诊断及治疗进展作一综述。     

自身免疫性胰腺炎

自身免疫性胰腺炎是一个全新的临床病种，其主要特征为具有特殊临床表现、组织病理学表现、实验室检查、影象检查的结果。本文简要论述自身免疫性胰腺炎的流行病学特性、临床表现、实验室检查、影像学检查、胃肠道、胰腺外病变，以此使临床医师对该病有比较全面的了解。     

自身免疫性胰腺炎诊治研究进展

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是由免疫介导的一种慢性胰腺炎,关于 AIP的研究报道主要来自日本,已有数百例AIP被报道,发病人群中以男性为主,平均发病年龄超过55岁,最小发病年龄为17岁[1].此外,韩国、德国、印度等国家均有散在报道,国内亦曾有报道.有关AIP的流行病学,仍需在不同的国家、不同种族间进行系统的大样本研究.现就AIP发病机制及其诊断和治疗的研究进展综述如下.     

自身免疫性胰腺炎研究进展

近年来，自身免疫性胰腺炎(AIP)作为一个临床实体受到越来越多的关注。与常见原因的慢性胰腺炎比较，该病具有鲜明的临床特征。临床上存在两种情况，即伴有其他疾病的继发性AIP和单独发生的原发AIP，其发病机理与CA-Ⅱ及LF等自身抗原成为靶抗原有关。CD4、CD8淋巴细胞识别HLAH类复合物以及CA-Ⅱ、LF等自身抗原肽发挥细胞毒作用或者作为免疫反应的辅助细胞导致AIP的发生，还可能与TGF信号调节缺失有关。诊断有赖于：(1)血清球蛋白或IgG水平升高；(2)出现自身抗体，尤其是ACA-Ⅱ阳性；(3)胰腺弥漫性增大，CT或MRI可见胰周边框征；(4)组织病理学检查提示胰实质纤维化改变伴淋巴细胞浸润；(5)皮质激素治疗有效。糖皮质类固醇是治疗AIP的有效方法，治疗后病情可以完全逆转。     

自身免疫性胰腺炎诊治研究进展

自身免疫性胰腺炎是一种由人体自身免疫异常所致的慢性胰腺炎,因其临床和影像表现与胰腺癌有相似之处,故误诊误治时有发生。由于本病缺乏特异性的临床表现和检测指标,故诊断通常需要对临床症状、影像表现、血清学检测结果、活检标本病理所见、类固醇药物治疗反应等进行综合分析。为提高临床医师对该疾病的认识,尽可能做到早期诊断和合理治疗,文章就自身免疫性胰腺炎在诊断和治疗方面的研究进展进行综述。     

自身免疫性胰腺炎的诊治进展

正自身免疫性胰腺炎(autoimmune pancreatitis,AlP)是一种由自身免疫介导的特殊类型的慢性胰腺炎,发病率约占慢性胰腺炎的5%~6%。1961年,Sarles等~[1]首先报道了1例伴有高γ球蛋白血症的非酒精性慢性胰腺炎,推测其病因与自身免疫有关。1995年,Yoshida等将这类慢性胰腺炎命名为AIP。2010国际共识的诊断标准(ICDC)将自身免疫性胰腺炎分为两     

自身免疫性胰腺炎的临床研究进展

自身免疫性胰腺炎（AIP）是一种临床表现、实验室检查及组织学检查均显示与自身免疫有关的慢性胰腺炎。该病往往表现为高γ球蛋白、IgG4升高，自身抗体[抗乳铁蛋白抗体（ALF）、抗碳酸酐酶-Ⅱ（ACAⅡ）、类风湿因子（RF）、抗核抗体（ANA）]阳性，显著的淋巴细胞浸润伴纤维化。典型病例的CT表现为胰腺弥漫性肿大呈腊肠样，周边低密度囊状缘，对激素治疗敏感。本病常表现为胰头肿物导致肝外梗阻性黄疸，容易被误诊为胰腺癌而行不必要的胰腺切除手术。     

Clinical usefulness and current problems of pancreatic duct stenting for preventing post-ERCP pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure with high frequency of accidental symptoms, and particularly some patients who develop and aggravate pancreatitis due to the procedure may need treatment of surgery or die. Various attempts were performed so far to prevent post-ERCP pancreatitis, however, it is impossible to completely prevent pancreatitis at this time because there are various factors for occurrence of post-ERCP pancreatitis. One of the most frequent causes of post-ERCP pancreatitis is considered to be congestion of pancreatic juice associated with duodenal papilledema after examination or treatment. Recently it is often reported that use of a pancreatic duct stent may prevent occurrence of pancreatitis which occurs because of an increased inner pressure of the pancreatic duct caused by congestion of pancreatic juice associated with duodenal papilledema. However, there are some patients who develop pancreatitis even if treated with the pancreatic duct stent, thus further clarification of the pathology and advancement of the prophylactic method will be needed.     

自身免疫性胰腺炎与胰腺癌在临床症状及血清学方面的鉴别诊断研究

目的 回顾性分析自身免疫性胰腺炎(AIP)患者及胰腺癌患者的临床症状及血清学特征,提高AIP与胰腺癌的鉴别诊断能力.方法 选取2003年1月至2011年10月我院外科收治的术后病理学结果符合亚洲标准的AIP患者36例及支持胰腺癌组织病理学诊断的患者95例,总结AIP与胰腺癌在临床症状、血清学等方面鉴别诊断的特点.结果 AIP与胰腺癌的鉴别特征:(1)胰腺癌患者年龄(60.9±9.0)岁高于AIP患者(53.56±14.6)岁(t=3.48,P＜0.05),AIP更倾向于男性(x2=2.88,P＜0.05);(2)AIP与胰腺癌的临床特征极易混淆,均有年龄特点,表现为低年龄症状相对典型,易早期发现,高年龄相对隐匿,易导致延误.(3) AIP更易合并胆系炎症(47.2％与12.6％,x2=18.12,P＜0.05),胰腺癌更易合并肝肾囊肿(29.5％与0,x2=13.50,P＜0.05);(4)高滴度CA199在诊断胰腺癌方面具有较高的价值[浓度:AIP组:20.51 (9.55,86.50) kU/L,胰腺癌组:326.50(94.38,10 393.00) kU/L;阳性率:AIP组:35.70％ (10/28),胰腺癌组:86.70％(65/75),P=0.000].高滴度淀粉酶[浓度:AIP组:103.50(72.00,252.00) U/L,胰腺癌组:46.50(21.65,96.90) U/L;阳性率:AIP组:45.00％ (9/20),胰腺癌组:19.40％ (7/36),P=0.043]、脂肪酶[浓度:AIP组:340.50(152.05,495.80) U/L,胰腺癌组:107.40(23.40,177.26) U/L,P=0.005]、天冬氨酸氨基转移酶[阳性率:AIP组:75.00％ (27/36),胰腺癌组:55.90％ (52/93),P=0.046]、γ-谷氨酰转肽酶[阳性率:AIP组:79.40％(27/34),胰腺癌组:57.10％(52/91),P=0.022]在诊断AIP方面具有较高的价值,CA199明显升高不是除外AIP的依据.结论 AIP做为一种特殊类型的慢性胰腺炎,在临床症状及血清学方面可与胰腺癌进行鉴别诊断.     

Diagnostic value of imaging examination in autoimmune pancreatitis

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis mediated by autoimmunity factors. It can be divided into two categories according to pathological characteristics: Lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric pancreatitis. In the clinical setting, the imaging manifestations of some AIP cases are atypical, so it is difficult to distinguish it from general pancreatitis, pancreatic ductal adenocarcinoma, lymphoma, and other malignant disorders. Most importantly, the treatment for and prognosis of these diseases are different. Therefore, a timely correct imaging diagnosis of AIP is key for AIP patients. After that, clinicians can take appropriate treatment measures for those patients, which is helpful for the prognosis of AIP.     

急性坏死性胰腺炎并胰管中断综合征的MRI表现

目的探讨急性坏死性胰腺炎所致胰管中断综合征的MRI特征。方法回顾性分析本院从2010年1月~2016年1月间急性胰腺炎住院病例因局部并发症行外科手术证实胰管中断的患者,均于发病后3~10 d行MRI检查且术前MRI检查。分析首次MRI检查上是否存在胰腺坏死,统计胰腺坏死部位、范围、深度、类型及MRSI评分;评价复查MRI上主胰管中断显示率、中断位置及与胰腺包裹性坏死的关系。结果共纳入胰管中断综合征患者26例(男15例,女11例,年龄50.2±15.2岁)进入研究,首次MRI检查均为急性坏死性胰腺炎,透壁性胰腺坏死占65.4%(17/26)、厚层性胰腺坏死占34.6%(9/26);胰腺内坏死厚度为2.4±0.3 cm(2~3.2 cm),坏死范围:50%者占61.5%(16/26)、30%~50%者占38.5%(10/26),MRSI评分为8.9±0.9分(8~10分)。MRI复查示73.1%(19/26)的患者见主胰管中断综合征的直接征象,即胰体部中断者占57.9%(11/19)、胰体尾交界区中断者占26.3%(5/19)、胰颈部中断者占15.8%(3/19)。所有病例均见胰腺包裹性坏死形成,19例患者上游胰腺组织内的主胰管如"苹果柄"状近直角汇入病灶并相通。结论急性胰腺炎厚层性/透壁性胰腺坏死致胰管中断综合征具有相应的MRI征象,后期出现的胰腺包裹性坏死为胰管中断综合征的并发症,可视为"厚层性/透壁性胰腺坏死-胰管中断-胰腺包裹性坏死"三部曲。     

磁共振胰胆管成像对正常胰管的评价

目的探讨正常胰管的磁共振胰胆管成像(MRCP)表现。方法300例无胰腺及相关病史者,用单次激发快速自旋回波序列,沿胰腺头、体、尾一系列多层多角度斜位厚层采集,观察各段胰管显示情况及走行。结果胰腺头、体、尾主胰管显示率99.3%、95.7%、87.3%;分支胰管、副胰管显示率4.67%、44.3%;胰腺分裂检出率7.7%;胰腺头、体、尾主胰管平均直径(2.36±0.60)mm、(2.05±0.72)mm、(1.67±0.86)mm;胰管走行:下降型(66.0%)、“S”型(16.0%)、垂直型(10.7%)和环型(9.3%)。结论MRCP能满意显示胰管正常解剖及变异。     

Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis?

Background  It is of utmost importance that autoimmune pancreatitis (AIP) be differentiated from pancreatic cancer. Irregular narrowing of the main pancreatic duct is a characteristic finding in AIP; it is useful for differentiating AIP from pancreatic cancer stenosis. This study evaluated the usefulness of magnetic resonance cholangiopancreatography (MRCP) for the diagnosis of AIP and assessed whether MRCP could replace endoscopic retrograde cholangiopancreatography (ERCP) for diagnosing AIP. Methods  The MRCP and ERCP findings of 20 AIP patients were compared. Results  On MRCP, the narrowed portion of the main pancreatic duct was not visualized, while the noninvolved segments of the pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder in AIP than in pancreatic cancer patients. In the skipped type, only skipped narrowed lesions were not visualized. After steroid therapy for AIP, the nonvisualized main pancreatic duct became visualized. Conclusions  MRCP cannot replace ERCP for the diagnosis of AIP, since narrowing of the main pancreatic duct in AIP was not visualized on MRCP. MRCP findings of segmental or skipped nonvisualized main pancreatic duct accompanied by a less dilated upstream main pancreatic duct may suggest the presence of AIP. MRCP is useful for following AIP patients.     

磁共振胆胰管成像显示"双管征"的意义

目的探讨"双管征"在诊断壶腹周围癌及胰腺良恶性病变方面的价值。方法对53例病人进行磁共振胆胰管成像(MRCP)检查并显示"双管征"。分析每一例病人的MRCP、轴位T1WI及T2WI,测量胆胰管汇合角度,十二指肠肠腔至胆胰管梗阻端的距离,胆胰管末端间距离,胆总管直径,胰管直径,观察胆总管末端形态,肝内胆管扩张程度,胰管形态,比较不同胰胆管疾病时"双管征"的差异。结果在胰头癌和慢性胰腺炎组"双管征",胆胰管汇合角度、十二指肠腔至胆胰管狭窄段距离及胰管直径较非胰头壶腹周围癌组大,差异有显著意义。"四节征"(13/27)和狭窄段侧支胰管扩张(6/27)多见于胰头癌。胰管粗细不均匀(9/10),边界不光滑,串珠状改变多见于慢性胰腺炎,这些征象与胰头癌组比较差异有显著意义(χ2=4.45,P<0.05)。3例(3/10)慢性胰腺炎伴有假囊肿,5例(5/10)伴有胰管结石。此外,与胰头癌组比较,慢性胰腺炎组的肝内胆管扩张较轻,胆总管末端以鼠尾状狭窄多见。结论在MRCP图像识别"双管征"的不同表现有助于诊断和鉴别诊断良恶性胰胆管疾病。     

局灶性自身免疫性胰腺炎与胰腺癌的CT鉴别诊断

目的探讨局灶性自身免疫性胰腺炎（AIP）的CT和临床特征,提高该病与胰腺癌的CT鉴别能力。方法回顾性分析复旦大学附属肿瘤医院9例经病理证实的局灶性AIP及9例胰腺癌患者的动态增强CT特征和临床表现。局灶性AIP选择美国梅奥医学中心AIP诊断标准,均由穿刺活检或手术病理证实;胰腺癌均由手术病理证实。对比病灶在部位、形态、强化方式、胰管改变、胰周及胰腺外改变等方面的不同。结果 9例局灶性AIP患者中,8例（88.9%）有局灶性胰腺肿大,1例（11.1%）外形正常。9例（100.0%）病灶均在CT平扫中呈相对低密度,8例（88.9%）增强后呈延迟强化,3例（33.3%）出现病灶远端胰管轻度扩张,以上特点与胰腺癌患者表现相比差异均有统计学意义。2例（22.2%）出现胰周包膜样改变。仅1例（11.1%）具有梗阻性黄疸及AIP合并硬化性胆管炎。3例（33.3%）有胰周淋巴结肿大。以上特征与胰腺癌患者表现相比差异无统计学意义。结论 CT对局灶性AIP与胰腺癌的鉴别诊断具有一定价值。     

Fentanyl-augmented MRCP

Background Drugs such as secretin and morphine have been used to augment the visualization of magnetic resonance cholangiopancreatography (MRCP). This study investigated the effectiveness of intravenous administration of a synthetic opioid, fentanyl, in improving the MRCP image quality. Methods Thirty consecutive patients with a provisional diagnosis of benign biliary and/or pancreatic disease underwent MRCP. Coronal single-shot fast spin-echo heavily T2-weighted dynamic MRCP images were generated before and at every minute for 10 min after intravenous administration of fentanyl citrate at a dose of 1.0 μg/kg. Pre- and postinjection images were compared and analyzed qualitatively and quantitatively. Results Qualitatively, visualization of intrahepatic bile ducts, common bile duct, and main pancreatic duct improved after fentanyl injection in five (16%), 11 (37%), and 19 (63%) patients, respectively. The pancreatobiliary junction and common channel were visualized better after fentanyl injection in eight of the 18 patients (44%). Quantitatively, signal intensity and diameters of the intrahepatic ducts, common bile duct, and main pancreatic duct measured at corresponding points on pre- and postinjection images showed an increase above preinjection values in 28 (93%), 27 (90%), and 21 (70%) and in 18 (60%), 26 (86%), and 22 (73%), respectively, and these changes were highly significant at all sites (p < 0.001). Conclusions Intravenous administration of fentanyl before MRCP improves qualitative and quantitative visualization of the ductal system anatomy that may be of value in clinical diagnosis and management.