慢性胰腺炎伴胰头部病变的外科手术处理

目的 探讨慢性胰腺炎伴胰头病变患者的外科处理。方法 回顾性总结分析了1998年10月至2001年12月收治27例慢性胰腺炎伴胰头病变患者的临床资料。其中：保留幽门的胰十二指肠切除（PPPI手术）14例（32例慢性胰腺炎的患者术前已有门静脉栓塞），保留十二指肠胰头切除（Beger手术）2例，胰头部分切除，胰空肠侧侧吻合（Frey手术）2例，胰十二指肠切除（Whipple手术）9例，结果 2例慢性胰腺炎合并门静脉血栓的患者术前先行门静脉取栓，降低门静脉压力，然后再针对慢性胰腺炎实行外科手术，术后1例恢复顺利，另1例死于多器官脏器功能衰竭，总的院内并发症率25%，总院内死亡率4%，其中PPPD手术后院内并发症率21%，院内死亡率7%。结论 慢性胰腺炎伴胰头肿大的患者的手术治疗应根据胰腺和邻近周围其它器官的形态学改变决定手术的方法。其结果不仅可以有效地治疗慢性胰腺炎，同时有助于提高胰头癌的诊治水平。     

胰腺癌的不典型64排螺旋CT影像表现

目的 分析胰腺癌的64排螺旋CT的不典型表现,以提高对该肿瘤的CT征象的认识水平.方法 回顾性分析经手术病理证实的缺乏典型CT征象的12例胰腺导管腺癌的64排螺旋CT资料.结果 12例均为胰腺导管腺癌.其中,中分化导管腺癌7例,中高分化导管腺癌1例;黏液腺癌1例;腺鳞癌3例.8例导管腺癌病灶中位于胰头及(或)钩突部7例,胰颈部1例,表现为等、低密度或囊实性肿块,增强后无明显强化;5例肿瘤呈明显外生性或有外生倾向;5例肿瘤远端胰管无扩张,2例出现胆总管和肝内胆管扩张,仅1例出现肿瘤远端胰腺萎缩.1例黏液腺癌CT平扫示胰头部5 cm囊性病灶,增强后仅囊性病灶下方少许实性部分轻度强化,体尾部胰管中度扩张(7 mmn),胆总管及邻近血管未受侵犯.3例腺鳞癌病灶中位于胰头2例,胰体部1例,肿块最大径3.0～4.5 cm,CT增强扫描胰腺实质期示3例病灶内均见液化坏死区,病灶远端胰管均轻度扩张(4～5 mm),胆总管和肝内胆管均未见扩张.结论 胰腺癌可出现不典型的CT影像表现,要注意与易混淆疾病进行鉴别诊断.     

胰腺腺鳞癌9例临床分析

目的：探讨胰腺腺鳞癌临床病理学特点和诊断治疗方法。方法：回顾性分析9例经手术和病理证实的胰腺腺鳞癌的临床、手术及病理资料。结果：本组共9例,77．8％（7／9）为老年患,肿瘤位于胰头6例,胰体尾3例。主要的临床表现是黄疸和腹痛,CT提示胰腺低密度占位。8例获手术切除,1例行胆囊空肠襻式吻合术。病理检查：瘤体平均直径为4．5cm,镜下表现为腺癌和鳞癌混杂。肿瘤侵犯十二指肠3例,侵犯肠系膜上静脉1例,侵犯脾静脉1例,侵犯胃1例,侵犯神经2例,淋巴结转移2例,肝转移1例。随访7例,术后生存3－17月,平均生存时间5．5月,均死于肿瘤复发和肝转移。结论：胰腺腺鳞癌呈侵袭性生长,易侵犯周围脏器和远处转移,恶性程度高,预后差;临床症状和影像学表现无特异性,术前确诊困难;手术切除是有效的治疗手段。     

Intraductal carcinoma in a surgically resected pancreas with chronic pancreatitis

A 59-yr-old Japanese male presented with epigastralgia. Endoscopic retrograde cholangiopancreatography (ERCP) revealed narrowing of the inferior common bile duct and protein plugs in the main pancreatic duct. He was diagnosed as suffering from chronic pancreatitis with suspicion of a pancreatic head tumor, and a pancreatoduodenectomy was performed. Histologically, a diffuse chronic pancreatitis was evident in the resected pancreas. Although no tumors were seen in the head portion of the pancreas around the inferior common bile duct, an intraductal carcinoma was found in the second branch of Santorini’s duct. Precancerous alteration of the duct epithelium, presenting papillary hyperplasia, and atypical hyperplasia were observed in areas continuous with the intraductal carcinoma. Immunohistochemically, carcinoembronic antigen (CEA) was specifically expressed in atypical hyperplasia and intraductal carcinoma, but not in papillary hyperplasia.     

Primary pancreatic lymphoma： Report of six cases

AIM: To heighten recognition of primary pancreatic lym phoma (PPL) in clinical practice. METHODS: A retrospective review of the clinical presentation, imaging characteristics and pathological features of PPL patients were presented, as well as their diagnosis and treatment, in combination with literature review. RESULTS: Histological diagnosis was made in four patients by surgery and in two patients by EUS-FNA. The six PPL patients (5 males and 1 female; age range, 16-65 years; mean age, 46 years) had the duration of symptoms for two weeks to three months. The primary presenting symptoms, though not characteristic, were abdominal pain, abdominal masses, weight loss, jaundice, nausea and vomiting. One of the patients developed acute pancreatitis. In one patient, the level of serum CA19-9 was 76.3μg/L. Abdominal CT scan showed that three of the six tumors were located in the head of pancreas, two in the body and tail, and one throughout the pancreas. Diameter of the tumors in the pancreas in four cases was more than 6 cm, with homogeneous density and unclear borders. Enhanced CT scan showed that only the tumor edges were slightly enhanced. The pancreatic duct was irregularly narrowed in two cases whose tumors were located in the pancreatic head and body, in which endoscopic retrograde cholangiopancreatography (ERCP) showed that the proximal segment was slightly dilated. Two patients underwent Whipple operation, one patient underwent pancreatectomy, and another patient underwent operative biliary decompression. PPL was in stage I E in 2 patients and in stage II E in 4 patients according to the Ann Arbor classification system. The diagnosis of B-cell non-Hodgkin's lymphoma was made in all patients histopathologically. All six patients underwent systemic chemotherapy, one of whom was also treated with gamma radiometry. One patient died two weeks after diagnosis, two patients lost follow-up, two patients who received chemotherapy survived 49 and 37 mo, and the remaining patient is still alive 21 mo, after diagnosis and treatment. CONCLUSION: PPL is a rare form of extranodal lympho-ma originating from the pancreatic parenchyma. Clinical and imaging findings are otherwise not specific in the differentiation of pancreatic lymphoma and pancreatic cancer, which deserves attention. EUS-guided fine-needle aspiration (EUS-FNA) of the pancreas requires experienced cytopathologists as well as advanced immunohis-tochemical assays to obtain a final diagnosis on a small amount of tissue. Surgery and adjuvant chemotherapy or radiotherapy can produce fairly good outcomes.     

胰腺假性囊肿内镜超声图像的特征

目的：研究胰腺假性囊肿内镜超声图像的特征，探讨内镜超声在胰腺假性囊肿诊断中的价值。方法：对35例胰腺假性囊肿患者进行超声内镜检查。结果：在35例胰腺假性囊肿中，单发3l例，多发4例，共有囊肿41个；位于胰头13个，胰体3个，胰尾19个，胰体尾6个。囊壁光滑29例，毛糙6例；囊液透声良好19例，有絮状回声16例，囊内有分隔l例，囊壁有钙化l例，伴有胰管扩张7例；胰腺实质回声不均匀21例，胰实质钙化4例，胰腺萎缩2例，胰腺癌2例，胰腺未见异常6例。5例在胃肠道有压迹，其中1例压迫十二指肠降段致梗阻；胃底静脉曲张4例，2例引起消化道出血。结论：内镜超声可以清晰显示囊肿的大小、部位、形态以及与胰腺的关系，且能进行EUS引导下的穿刺检查，对假性囊肿的诊断和鉴别诊断均有重要意义。     

Utility of fusion CT-PET in the diagnosis of small pancreatic carcinoma

Pancreatic carcinoma has a poor prognosis and early detection is essential for potentially curative resection. Despite the wide array of diagnostic tools, preoperative detection of small pancreatic carcinomas remains difficult. We report a case of small pancreatic carcinoma of the head of pancreas with indeterminate findings on US, ERCP, MRI and EUS which was successfully diagnosed via fusion CT-PET. This case illustrates the utility of CT-PET in the diagnosis of patients with small pancreatic carcinoma with equivocal findings on conventional diagnostic modalities.     

Differentiation of Pancreatic Tumours by Conventional Ultrasound,Unenhanced and Echo-Enhanced Power Doppler Sonography

Background: Echo-enhanced power Doppler sonography (power Doppler sonography after injection of a contrast agent) is a non-invasive and increasingly used procedure for differentiating between pancreatic tumours. However, the diagnostic accuracy of this method compared to conventional ultrasound or unenhanced power Doppler sonography has never been investigated in a large prospective controlled study. Methods: 137 patients were included in the study, selected from 190 consecutive patients with a mean age of 60 years (range 16-85) who presented at our department in the period January 1998 through June 2001 with clinical suspicion of a pancreatic tumour. Sonography was performed by an experienced examiner blind to the patients' clinical diagnoses. The exact diagnosis was based on histological evidence from biopsy examination (surgical and fine needle biopsy) or on a follow-up of at least 18 months. Results: Of the 137 patients, 47 had pancreatic cancer; 41 had masses associated with pancreatitis; 17 had neuroendocrine tumours; 12 had cystic lesions of the pancreas; and 10 had other pancreatic diseases. A normal pancreas was found in 10 patients. The sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing pancreatic carcinoma was 87% and its specificity 94%. The corresponding values for chronic pancreatitis were 85% and 99%, respectively. Conclusions: Echo-enhanced power Doppler sonography has a high sensitivity and specificity in the differential diagnosis of pancreatic tumours. However, histology is the standard of reference.     

胆胰管良恶性梗阻的双支架联合引流

目的 探讨胆、胰管良恶性狭窄或梗阻时内镜双支架联合引流的操作技术及其临床疗效。方法 所有患者先行经内镜逆行胰胆管造影，了解胆、胰管狭窄或梗阻的部位、程度，并确定置入支架的外径及长度；然后胆、胰管分别置入导丝，并在导丝引导下按常规分别置入胆管和胰管引流支架。术后观察血清淀粉酶变化及黄疸、腹痛、腹泻等临床症状的改善情况。结果 14例胆、胰管并存狭窄或梗阻患者（壶腹癌5例、胰头癌4例、乳头部癌3例及胰头部慢性炎症2例）均一次操作成功，置入胆管塑料支架14根（12例1根，1例2根），置入金属支架1根；同时还置入胰管支架14根。术后2周、1个月及3个月黄疸消失率分别为50．0％、71．0％和93．0％，术后2周上腹痛缓解率为75．0％；7例腹泻患者，术后1个月5例症状消失，2例明显减轻。未发生与操作相关的早期并发症，术后3个月未发现支架移位及阻塞情况。结论 胆、胰管良恶性狭窄患者经内镜双支架联合引流是一种简便、安全、有效的治疗方法，既能解除黄疸，又能减压止痛，改善胰腺外分泌功能。     

A case of long survival in poorly differentiated small cell carcinoma of the pancreas

Small cell carcinoma （SCC） of the pancreas is rare. It has similar histological features to pulmonary small cell carcinoma and is equally aggressive. Most patients with SCC in the pancreas reported in case studies died within 1 year after diagnosis. We present a case of unusually long-term survival after surgery and combined chemotherapy for SCC of the pancreas. A 62-year-old woman presented with epigastric pain and jaundice. Computed tomography revealed dilated common bile duct caused by external compression of the mass in the pancreatic head. Exploratory laparotomy and pancreaticoduodenectomy （PPPD） was performed with histopathological analysis confirming a primary small cell carcinoma of the pancreas. After an uneventful postoperative recovery, the patient was treated with 6 cycles of combined chemotherapy consisting of cisplantin and ectoposide. During the follow-up, there was no evidence of recurrence and the patient has remained in a good health condition for 36 mo since the diagnosis.     

胰腺肿瘤64层灌注CT成像特征的初步分析

目的 应用64层螺旋CT灌注扫描成像技术描述正常胰腺和胰腺肿瘤的血流动力学特征,探讨灌注CT在胰腺肿瘤诊断中的应用价值.方法 对36例非胰腺疾病(对照)、105例胰腺肿瘤和8例十二指肠乳头癌进行胰腺CT灌注扫描,分别测量血流量(BF)、血容量(BV)和表面通透性(PS)值.结果 正常胰腺组织BF、BV和PS的平均值分别为(135.24±48.36)ml·min-1·Kg-1、(200.55±54.96)ml/kg和(49.75 4±24.27)ml·min-1·kg-1;胰腺癌分别为(31.77±19.36)ml·min-1·kg-1、(66.84±39.49)ml/kg和(37.64 4±27.14)ml·min-1·kg-1;十二指肠乳头癌分别为(93.04±48.13)ml·min-1·Kg-1、(97.12±89.80)ml/kg和(41.08±18.85)ml·min-1·kg-1;胰腺囊肿的3项参数值接近零.胰腺癌的3项灌注参数均显著低于正常胰腺(P<0.05);十二指肠乳头癌的BF和BV值显著低于正常胰腺(P<0.05),而PS值与正常胰腺无显著差异;胰腺囊肿与正常胰腺差异非常显著(P<0.01).结论 正常胰腺CT灌注表现为组织血流量、血容量均匀,毛细血管表面通透性一致的实质性器官;胰腺癌表现为低灌注和毛细血管表面通透性降低的肿瘤;十二指肠乳头癌仅表现为低灌注,表面通透性不变;胰腺囊肿内无血流灌注.64层灌注CT有助于胰腺肿瘤的鉴别诊断.     

Role of endoscopic ultrasound guided FNAC in diagnosis of pancreatic TB presenting as mass lesion: a case report and review of literature

A 24-year-old male patient presented with abdominal pain, obstructive jaundice, anorexia and weight loss. Ultrasound abdomen revealed pancreatic head mass with dilated common hepatic duct and intrahepatic bliliary radicles. CECT abdomen was suggestive of pancreatic head mass invading portal vein, splenic artery and hepatic artery. Provisional diagnosis of unresectable carcinoma head of pancreas was established. Endoscopic ultrasound (EUS) was done, which was also suggestive of pancreatic head mass infiltrating portal vein. EUS guided Fine Needle Aspiration Cytology (FNAC) was taken with an intent to obtain tissue diagnosis and to start palliative chemotherapy. EUS guided FNAC features were suggestive of tuberculosis (TB). Patient was started on anti-tubercular therapy, to which he responded and was cured. Pancreatic tuberculosis should be considered as a possibility, in pancreatic mass, especially in countries where TB is endemic and establishing its diagnosis with the aid of FNAC can save trauma of major surgery to the patient, which prompted us to report this case.     

A case of pancreatic carcinoma with suspected autoimmune pancreatitis

We present a case of pancreatic carcinoma with strongly suspected coexisting autoimmune pancreatitis (AIP). The patient presented with a chief complaint of icterus and weight loss, and was referred to our institution after a pancreatic lesion was found. Blood test showed elevation of serum bilirubin, hepato-biliary enzyme, glucose and tumor markers, and also high levels of serum IgG4 (344 mg/dl, normal 4.8–105 mg/dl) and anti-DNA antibody (14 IU/ml, normal <6.0 IU/ml). Ultrasonography demonstrated an enlarged pancreas with smooth borders and low internal echo density. Enhanced computed tomography (CT) showed a sausage-shaped pancreas without definitive metastasis to the surrounding lymph nodes and liver. Imaging of the pancreatic duct, including endoscopic retrograde pancreatography (ERP) and magnetic resonance cholangiopancreatography (MRCP), showed stenosis of the main pancreatic duct at the pancreatic head as well as a long segment of narrowing at the body and no dilatation at the tail. Tissues from these stenotic sites and open biopsy from pancreatic body showed infiltrating adenocarcinoma and dense fibrosis. To date, only a small number of reports have described pancreatic carcinoma accompanied with AIP. It is important to confirm diagnosis with histology in cases of suspicious autoimmune pancreatitis, even when the clinical images are compatible with AIP.     

Curative resection for left-sided pancreatic malignancy

Background. Surgical technique in pancreatic cancer has seen significant developments, but much of the knowledge refers to pancreatic head carcinoma. Reports on the management of tumours of the body and tail have been less frequent. Current knowledge teaches that adenocarcinomas of the body and tail of the pancreas have a worse prognosis. The aim of this study is to report the short- and long-term outcome in 20 patients with left-sided pancreatic malignancy, where ‘resection for cure’ was done. Patients and methods. Retrospective study of demographic data, symptomatology, diagnostic methods, operative management, pathology report, postoperative morbidity and mortality. Results. Postoperative complications were seen in 40% of patients. One patient died on day 5 from sepsis with multiple organ failure. Other complications were intra-abdominal bleeding, bleeding from the gastroentero-anastomosis, postoperative jaundice, pleural exudate, wound dehiscence and intra-abdominal abscess. The patients with ductal adenocarcinoma had a median survival of 14 months and a 5-year survival of 17%. The median survival for the whole group of patients was 17 months and the 5-year survival was 23%. One patient with malignant insulinoma and two patients with adenocarcinoma had a survival exceeding 5 years (98, 174 and 183 months, respectively). Discussion. Selected patients with left-sided pancreatic adenocarcinoma may be operated on with results similar to pancreaticoduodenectomy (Whipple procedure) for cancer of the pancreatic head regarding postoperative morbidity and mortality as well as long-term survival. Thus, although left-sided pancreatic cancer generally appears at a more advanced stage, it seems true that treatment results are similar if radical excision can be achieved.     

Differentiation of pancreatic tumours by conventional ultrasound,unenhanced and echo-enhanced power Doppler sonography

BACKGROUND: Echo-enhanced power Doppler sonography (power Doppler sonography after injection of a contrast agent) is a non-invasive and increasingly used procedure for differentiating between pancreatic tumours. However, the diagnostic accuracy of this method compared to conventional ultrasound or unenhanced power Doppler sonography has never been investigated in a large prospective controlled study. METHODS: 137 patients were included in the study, selected from 190 consecutive patients with a mean age of 60 years (range 16-85) who presented at our department in the period January 1998 through June 2001 with clinical suspicion of a pancreatic tumour. Sonography was performed by an experienced examiner blind to the patients' clinical diagnoses. The exact diagnosis was based on histological evidence from biopsy examination (surgical and fine needle biopsy) or on a follow-up of at least 18 months. RESULTS: Of the 137 patients, 47 had pancreatic cancer; 41 had masses associated with pancreatitis; 17 had neuroendocrine tumours; 12 had cystic lesions of the pancreas; and 10 had other pancreatic diseases. A normal pancreas was found in 10 patients. The sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing pancreatic carcinoma was 87% and its specificity 94%. The corresponding values for chronic pancreatitis were 85% and 99%, respectively. CONCLUSIONS: Echo-enhanced power Doppler sonography has a high sensitivity and specificity in the differential diagnosis of pancreatic tumours. However, histology is the standard of reference.     

影响胰头、壶腹部癌患者胰十二指肠切除术后生存的因素

目的分析影响胰头癌、壶腹部癌行胰十二指肠切除术的患者生存期的因素。方法收集1990年1月至2005年6月因胰头癌、壶腹部癌行胰十二指肠切除术的95例患者,有完整随访资料的68例纳入分析。观察的影响因素包括性别,年龄,术前黄疸、GPT、贫血,临床分期,原发肿瘤大小,淋巴结转移,住院期间输血量。Kaplan-Meier法计算累计生存率,单因素分析采用Logrank法,多因素分析采用COX回归模型。结果胰头癌1年、2年、3年生存率分别为37%,12%,12%;壶腹部癌1年、2年、3年生存率分别为60%,38%,31%。单因素分析提示,胰头癌患者的临床分期、肿瘤大小、淋巴结转移及输血量与预后有关(P<0.05);壶腹部癌患者的各观察指标与预后的关系无统计学意义。多因素分析提示输血是胰头癌的独立预后因素;壶腹部癌患者无明确的影响预后的独立因素。结论输血是影响胰头癌预后的独立因素,加强围手术期处理有助改善胰头癌患者的预后。     

胰管结石影像特点及临床处理策略

目的 探讨胰管结石影像学特点及选择治疗策略。方法 对43例胰管结石的影像学特点进行回顾性分析，总结结石分布部位、大小、胰管形态学特点、诊断方法和内科保守治疗方法、ERCP取石以及外科手术治疗方法的选择。结果 43例胰管结石经影像学诊断42例，1例术中探查发现；其中B超确诊20例，CT10例，ERCP12例。结石位于胰头部10例，胰体、尾部29例，广泛分布4例。对20例位于胰体、尾部的单发胰管结石患者行内科保守治疗；6例结石位于胰头部者行ERCP乳头切开取石；17例患者胰管结石为多发，且广泛分布，大小在0．8～2．5cm，并伴有胰管形态学改变，经手术治疗痊愈。结论B超、CT或ERCP是确诊胰管结石较理想的方法，根据结石的特点选择治疗方案和手术术式在胰管结石治疗中具有重要意义。     

Risk factors of pancreatic leakage after pancreaticoduodenectomy

AIM: To analyze the risk factors for pancreatic leakage after pancreaticoduodenectomy (PD) and to evaluate whether duct-to-mucosa pancreaticojejunostomy could reduce the risk of pancreatic leakage. METHODS: Sixty-two patients who underwent PD at our hospital between January 2000 and November 2003 were reviewed retrospectively. The primary diseases of the patients included pancreas cancer, ampullary cancer, bile duct cancer, islet cell cancer, duodenal cancer, chronic pancreatitis, pancreatic cystadenoma, and gastric cancer. Standard PD was performed for 25 cases, PD with extended lymphadenectomy for 27 cases, pylorus-preserving PD for 10 cases. A duct-to-mucosa pancreaticojejunostomy was performed for patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy for patients with a soft pancreas and a non-dilated duct. Patients were divided into two groups according to the incidence of postoperative pancreaticojejunal anastomotic leakage: 10 cases with leakage and 52 cases without leakage. Seven preoperative and six intraoperative risk factors with the potential to affect the incidence of pancreatic leakage were analyzed with SPSS10.0 software. Logistic regression was then used to determine the effect of multiple factors on pancreatic leakage. RESULTS: Of the 62 patients, 10 (16.13%) were identified as having pancreatic leakage after operation. Other major postoperative complications included delayed gastric emptying (eight patients), abdominal bleeding (four patients), abdominal abscess (three patients) and wound infection (two patients). The overall surgical morbidity was 43.5% (27/62). The hospital mortality in this series was 4.84% (3/62), and the mortality associated with pancreatic fistula was 10% (1/10). Sixteen cases underwent duct-to-mucosa pancreaticojejunostomy and 1 case (1/16, 6.25%) developed postoperative pancreatic leakage, 46 cases underwent invagination pancreaticojejunostomy and 9 cases (9/46, 19.6%) developed postoperative pancreatic leakage. General risk factors including patient age, gender, history of jaundice, preoperative nutrition, pathological diagnosis and the length of postoperative stay were similar in the two groups. There was no statistical difference in the incidence of pancreatic leakage between the patients who received the prophylactic use of octreotide after surgery and the patients who did not undergo somatostatin therapy. Moreover, multivariate logistic regression analysis showed that none of the above factors seemed to be associated with pancreatic fistula. Two intraoperative risk factors, pancreatic duct size and texture of the remnant pancreas, were found to be significantly associated with pancreatic leakage. The incidence of pancreatic leakage was 4.88% in patients with a pancreatic duct size greater than or equal to 3 mm and was 38.1% in those with ducts smaller than 3 mm (P = 0.002). The pancreatic leakage rate was 2.94% in patients with a hard pancreas and was 32.1% in those with a soft pancreas (P = 0.004). Operative time, blood loss and type of resection were similar in the two patient groups. The incidence of pancreatic leakage was 6.25% (1/16) in patients with duct-to-mucosa anastomosis, and was 19.6% (9/46) in those with traditional invagination anastomosis. Although the difference of pancreatic leakage between the two groups was obvious, no statistical significance was found. This may be due to the small number of patients with duct-to-mucosa anastomosis. By further analyzing with multivariate logistic regression, both pancreatic duct size and texture of the remnant pancreas were demonstrated to be independent risk factors (P = 0.007 and 0.017, OR = 11.87 and 15.45). Although anastomotic technique was not a significant factor, pancreatic leakage rate was much less in cases that underwent duct-to-mucosa pancreaticojejunostomy. CONCLUSION: Pancreatic duct size and texture of the remnant pancreas are risk factors influencing pancreatic leakage after PD. Duct-to-mucosa pancreaticojejunostomy, as a safe and useful anastomotic technique, can reduce pancreatic leakage rate after PD.     

Multiple late asymptomatic pancreatic metastases from renal cell carcinoma: diagnosis by endoscopic ultrasound-guided fine needle aspiration biopsy with immunocytochemical correlation

We describe a patient who presented with multiple asymptomatic masses detected in the pancreas. Twelve years prior to this presentation, he underwent a left radical nephrectomy for stage I renal cell carcinoma. CT-guided biopsy was unsuccessful. Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) biopsy was performed. Adequate material was obtained for various immunocytochemical stains that supported the diagnosis of renal cell carcinoma metastatic to the pancreas. The patient was referred for appropriate therapy. This case illustrates that metastasis to the pancreas from renal cell carcinoma can present years after the original diagnosis. We conclude that EUS-FNA can provide tissue diagnosis from pancreatic masses, especially when other modalities have failed.     

胰头癌、壶腹部癌274例临床与病理诊断分析

目的探讨胰头、壶腹部癌临床与病理诊断的符合率,提高临床诊断水平。方法回顾性分析1981年1月-2002年12月临床诊断的胰头、壶腹部癌274例。将274例患者分为3组:A组(胰十二指肠切除术)163例,B组(肿瘤未切除者)66例,C组(单纯内镜检查)45例。结果临床诊断胰头、壶腹部痛27d例,与病理诊断比较符合率为73.7%(202/274)。A组临床诊断与病理诊断比较符合率93.2%(152/163),B组为45.4%(30/66),C组为42.2%(19/45)。在122例胰头肿块中,胰头癌符合率为68.85%(84/122),其中A组胰头癌符合率89.71%(61/68),B组43.14%(22/1),C组33.3%(1/3)。在150例壶腹部肿块中,壶腹癌诊断符合率为72.0%(108/150),其中A组为88.17%(82/93),B组为53.3%(8/15),C组为42.85%(18/42)。2例为转移癌。胰头、壶腹部癌临床与病理诊断不符合72例(26.3%),其中15例为慢性胰腺炎,16例为慢性十二指肠黏膜炎,8例为十二指肠黏膜上皮不典型增生和33例其他疾病。B超、CT、内镜、ERCP、血清标志物和PGGT、PGGT/TGGT的联合检测,发现早期胰头壶腹部癌(T1N0M0)30例(13.1%,30/229),其中早期胰头癌9例(10.7%,9/84),早期壶腹部癌21例(14.5%,21/145)。结论早期胰头、壶腹部癌(T1N0M0)诊断困难,应提高其诊断水平;胰头癌和胰头肿块型慢性胰腺炎的鉴别诊断十分重要;在组织病理学确诊胰头、壶腹部癌以前,胰十二指肠切除必须慎重。