自身免疫性胰腺炎的CT表现特征(附4例分析)

目的探讨自身免疫性胰腺炎(AIP)的CT表现特征。方法收集4例经临床、实验室检查和类固醇激素治疗有效的AIP患者的CT资料。CT检查包括平扫、双期(动脉期和门静脉期)增强扫描,在CT图像上观察胰腺的形态、大小、质地、强化程度、胰管、胰腺边缘、胰周及腹膜后各间隙等情况并分析AIP的CT表现特征。结果3例AIP表现为胰腺弥漫性肿大,1例为胰头的局限性肿大;病变区域胰腺实质在动脉期强化减弱但出现明显的延时强化;2例在胰腺病变区周围环绕包膜样结构;2例伴胆总管胰头段狭窄,1例ERCP显示胰管不规则狭窄;经类固醇激素治疗后,CT复查显示胰腺情况明显好转。结论AIP的CT表现具有一定的特征性。     

自身免疫性胰腺炎的影像表现:7例报道及文献复习

目的:探计自身免疫性胰腺炎(AIP)在动态对比的增强CT(DCE-CT)和内镜逆行胰胆管造影(ERCP)中的影像学特点.方法:对7例AIP患者进行动态增强CT及ERCP检查,并采用超声(US)随访AIP类固醇治疗的效果.结果:治疗前ERCP检查,主胰管狭窄段和无病变胰管显示清楚;各例AIP均显示主胰管弥漫性、阶段性或多处局限性狭窄,狭窄段上游胰管轻中度扩张;4例合并胆总管下端狭窄或阻塞.DCE-CT,胰腺显示弥漫性或局限性肿胀,其中3例病灶边缘可见包膜样低密度表现.类固醇治疗后,胰腺肿胀减轻、胆管狭窄的改善.结论:AIP的形态学改变具有一定特征性,ERCP与DCE-CT相结合有助于AIP的诊断.     

自身免疫性胰腺炎的诊治及外科手术价值研究

目的总结自身免疫性胰腺炎(AIP)的诊治经验,探讨外科手术在其治疗中的价值。方法回顾性分析2013年1月至2017年6月福建医科大学附属协和医院收治的17例AIP病人的临床资料。观察临床表现、血液检查结果、影像学表现、诊断及治疗、随访情况。结果 (1)临床表现:17例病人中,7例有梗阻性黄疸,8例上腹痛,1例反复腹泻,1例为因体检发现胰腺肿物。共有11例病人存在胰腺外器官受累。(2)血液检查:13例病人血清免疫球蛋白G4(IgG4)升高,2例正常,2例未查。4例病人CA19-9升高,13例正常。3例病人血清淀粉酶轻度升高,14例正常。(3)影像学检查:所有17例病人均行胰腺CT平扫+增强检查,12例CT表现为弥漫型,5例CT表现为局灶型。(4)诊断及治疗:17例病人均确诊为1型AIP。17例病人中有3例因影像学疑似胰腺癌行手术治疗,术后病理学检查证实为AIP,包括胰十二指肠切除术2例和胰体尾+脾切除术1例。14例AIP病人接受初始口服激素治疗,11例缓解,1例因CA19-9持续升高行胰体尾+脾切除术,1例因胰头假性囊肿逐渐增大伴梗阻性黄疸行胰十二指肠切除术,1例因胰体假性囊肿伴腹痛行胰体囊肿空肠内引流术。(5)随访情况:17例病人均获得随访,平均随访时间为29(12～66)个月。3例初始接受手术的病人术后疾病缓解,复查未见复发。14例接受激素初始治疗的病人,11例有效,疾病缓解;另3例接受手术后继续口服激素治疗3个月,未见复发。结论 AIP的诊断须综合临床表现、血清学、影像学和病理学等检查结果,应用激素是治疗AIP最主要的方法,但外科手术仍占有重要地位,尤其适用于难以与胰腺癌鉴别的局灶型AIP和激素治疗效果欠佳的AIP合并假性囊肿。     

自身免疫性胰腺炎的诊治及外科手术价值研究

目的 总结自身免疫性胰腺炎（AIP）的诊治经验，探讨外科手术在其治疗中的价值。方法 回顾性分析2013年1月至2017年6月福建医科大学附属协和医院收治的17例AIP病人的临床资料。观察临床表现、血液检查结果、影像学表现、诊断及治疗、随访情况。结果 （1）临床表现：17例病人中，7例有梗阻性黄疸，8例上腹痛，1例反复腹泻，1例为因体检发现胰腺肿物。共有11例病人存在胰腺外器官受累。（2）血液检查：13例病人血清免疫球蛋白G4（IgG4）升高，2例正常，2例未查。4例病人CA19-9升高，13例正常。3例病人血清淀粉酶轻度升高，14例正常。（3）影像学检查：所有17例病人均行胰腺CT平扫+增强检查，12例CT表现为弥漫型，5例CT表现为局灶型。（4）诊断及治疗：17例病人均确诊为1型AIP。17例病人中有3例因影像学疑似胰腺癌行手术治疗，术后病理学检查证实为AIP，包括胰十二指肠切除术2例和胰体尾+脾切除术1例。14例AIP病人接受初始口服激素治疗，11例缓解，1例因CA19-9持续升高行胰体尾+脾切除术，1例因胰头假性囊肿逐渐增大伴梗阻性黄疸行胰十二指肠切除术，1例因胰体假性囊肿伴腹痛行胰体囊肿空肠内引流术。（5）随访情况：17例病人均获得随访，平均随访时间为29（12～66）个月。3例初始接受手术的病人术后疾病缓解，复查未见复发。14例接受激素初始治疗的病人，11例有效，疾病缓解；另3例接受手术后继续口服激素治疗3个月，未见复发。结论 AIP的诊断须综合临床表现、血清学、影像学和病理学等检查结果，应用激素是治疗AIP最主要的方法，但外科手术仍占有重要地位，尤其适用于难以与胰腺癌鉴别的局灶型AIP和激素治疗效果欠佳的AIP合并假性囊肿。     

自身免疫性胰腺炎1例报告并国内文献复习

目的 探讨自身免疫性胰腺炎（AIP）的临床特征及其诊断与治疗。方法 报告中国医科大学附属第一医院2011年3月收治1例AIP的临床资料,并检索2001年1月至2010年12月国内10年文献报道18篇107例。对所有108例AIP临床表现、实验室检查、影像学检查、治疗方法及随访资料进行分析。结果 男98例,女10例。临床表现为梗阻性黄疸80例次,上腹部不适或疼痛50例次。健康检查发现1例（无症状）。行CA19-9检查86例中38例(44.2%)阳性,多为轻度升高。行免疫球蛋白（IgG）检查81例中56例（69.1%）升高,行球蛋白或γ球蛋白检查42例中29例（69.0%）升高。行B超及CT检查,108例中弥漫性胰腺肿大54例（50.0%）,局限性肿大54例（50.0%）,主要为胰头部肿大（51例）,胰体部或胰体尾部肿大仅3例。53例行手术治疗,63例行激素治疗。应用激素治疗者2例无效,其余临床症状均有所缓解。7例复发,再次应用激素治疗后症状缓解。结论 AIP好发于中老年男性（55岁左右）,多以梗阻性黄疸、腹部不适首诊,伴有IgG和球蛋白的升高,影像学以胰腺弥漫性或局限性肿大为特征,激素治疗效果良好。     

DWI及ADC值对AIP、胰腺癌手术的诊断价值

目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值对自身免疫性胰腺炎(AIP)、胰腺癌手术的诊断价值。方法对2015年2月至2020年12月在本院治疗的30例AIP患者及22例胰腺癌患者的临床资料进行回顾性分析,分别设为AIP组与胰腺癌组。比较两组患者病变的DWI序列表现(包括形态、累及范围)、最大直径以及ADC值。结果全部AIP与胰腺癌DWI(b=800s/mm2)显示的病灶与相邻组织比较表现为高信号。AIP病患中20例表现为弥漫性肿大形态属于腊肠型,7例于胰腺体尾部呈现出节段性肿大形态属于腊肠型,只有3例于胰头区呈现出局灶性肿大形态属于肿块型;胰腺癌病患中20例呈现出局灶性肿块,2例于胰腺头体部呈现出弥漫性肿大,于胰尾部出现萎缩,8例合并双管征,2例于肝内出现转移灶,14例胰腺组织远端萎缩同时合并胰管扩张;AIP组弥漫性受累及腊肠型形态明显多于胰腺癌组,差异有统计学意义(P0.05);两组病灶的最大直径相比,差异无统计学意义(P0.05);AIP组的ADC值明显低于胰腺癌组,差异有统计学意义(P0.05)。结论 DWI及ADC值对AIP、胰腺癌手术的诊断价值较高。     

CT与MRI检查对自身免疫性胰腺炎的诊断价值

目的 探讨CT与MRI检查对自身免疫性胰腺炎（AIP）的诊断价值。方法 回顾性分析2011年 6月至2013年12月期间眉山市中医医院收治的14例AIP患者的临床和影像学资料。结果 CT和MRI检查示AIP患者的胰腺弥漫性肿大呈腊肠状,T1WI示胰腺实质信号明显减低,扩散加权成像（DWI）示胰腺实质信号明显增高;增强扫描后动脉期胰腺实质强化幅度明显降低,延迟期呈持续性延迟强化伴包膜征,胆总管胰腺段呈鸟嘴样狭窄。结论 AIP的影像学表现具有一定的特征性,结合临床表现及实验室检查可早期诊断,对选择治疗方案具有重要意义。     

自身免疫性胰腺炎的诊治进展

自身免疫性胰腺炎(autoimmune pancreatitis, AIP)是一种特殊类型的慢性胰腺炎, 以胰腺弥漫性肿大及胰管不规则狭窄、淋巴细胞及浆细胞组织浸润、血清免疫球蛋白4(immunoglobulin G4, IgG4)水平升高、伴或不伴有胰外器官受累为特征。AIP起病隐匿, 症状和体征缺乏特异性, 容易与胰腺癌、胆管癌相混淆。目前临床医生对该疾病认识不足, 缺乏相关诊疗经验, 部分患者因误诊而接受了不必要的手术治疗。本文对AIP的诊治进展作一综述, 以期提高临床医师对该疾病的认识。     

自身免疫性胰腺炎的诊断

自身免疫性胰腺炎（AIP）是由自身免疫介导,以梗阻性黄疸、胰腺肿大、胰管不规则狭窄、淋巴浆细胞浸润并纤维化、伴或不伴胰外器官受累为特征．对激素治疗敏感的一种特殊类型的慢性胰腺炎。临床上AIP诊断十分困难,且临床及病理医师对其亦认识不足,误诊率较高。因AIP常以梗阻性黄疸、胰腺肿大为特征,故易误诊为胰腺肿瘤而采取不必要的手术切除。增加对AIP的认识,提高诊断正确率,对改善AIP的诊断现状和治疗水平尤为重要。     

胰头肿块型自身免疫性胰腺炎手术治疗的临床效果

目的 探讨胰头肿块型自身免疫性胰腺炎(AIP)手术治疗的临床效果.方法 回顾性分析2008年5月至2013年5月吉林大学中日联谊医院收治的19例胰头肿块型AIP患者的临床资料,其中伴胆囊结石2例.采用剖腹探查根据术中病理检查结果进一步决定治疗方式.采用门诊及电话方式进行随访,随访时间截至2014年1月.结果 19例患者均成功完成手术,其中11例行胰十二指肠切除术,5例行单纯剖腹探查术,3例行胆囊切除+胆肠吻合术.手术时间为(249±140) min(50 ～ 390 min),术中出血量为(320±260) mL(50 ～ 900 mL),术后平均胃肠功能恢复时间为3.0d(2.0～6.0 d),术后平均住院时间为22.6 d(8.0～30.0 d).12例患者术后IgG4水平升高,平均为2.64 g/L.患者术后发生并发症5例,其中胰液漏2例,手术切口脂肪坏死液化合并感染2例,胆汁漏1例,均经对症处理后痊愈.围手术期无患者死亡.19例患者均获得随访,随访时间为11.0 ～36.0个月,中位随访时间为28.2个月.8例未行胰十二指肠切除术患者出院后开始口服泼尼松,复查胰腺CT或MRI,均提示胰头肿块减小或消失.其余11例行胰十二指肠切除术患者均健康生存.结论 对不典型胰头肿块型病变比如AIP的治疗,应积极与患者及家属沟通,行剖腹探查术,术中穿刺活组织检查,根据病理检查结果,选择手术或药物治疗.     

自身免疫性胰腺炎的CT和MRI的影像学表现

目的探讨自身免疫性胰腺炎CT和MRI的影像学特点,提高对自身免疫性胰腺炎的认识和影像学诊断水平。方法回顾性分析45例经激素治疗或手术病理证实的自身免疫性胰腺炎患者的CT和MRI影像学资料,观察胰腺及周围组织、胰管和胆管的影像学表现,总结自身免疫性胰腺炎CT和MRI的影像学特点。结果 45例自身免疫性胰腺炎患者中,男性32例,女性13例,其中37例患者表现为胰腺的弥漫性肿大,8例患者表现为胰腺局限性肿大,CT检查中有27例患者的胰腺病灶平扫密度减低;MRI检查中有16例患者胰腺病灶出现信号的改变,表现为T1WI上低信号,T2WI上稍高信号;45例患者胰腺病灶均表现为延迟强化方式改变。10例患者的CT和7例患者的MRI表现为胰管狭窄,2例患者的CT和1例的患者MRI表现为胆总管狭窄。14例患者的CT及MRI表现胰腺周围的"假包膜"征象。结论自身免疫性胰腺炎在CT和MRI上具有一定的影像学特点,结合实验室相关检查有助于该疾病的诊断。     

Autoimmune pancreatitis with multifocal lesions

Two cases of a focal type of autoimmune pancreatitis (AIP) with distinct double mass lesions within the pancreas are described. In both patients, computed tomography (CT) showed localized pancreatic masses with delayed enhancement, and magnetic resonance cholangiopancreatography (MRCP) revealed localized stenoses of the main pancreatic duct (MPD) with mild upstream dilatation. Fluorodeoxyglucose positron emission tomography (FDG-PET) examination, performed in one patient, showed intense uptake concordant with tumors. Both patients received pancreatic resection with a presumptive diagnosis of pancreatic carcinoma. Histologic evaluation of the tumors showed marked lymphoplasmacytic infiltration and fibrosis around the large and medium pancreatic ducts, without any evidence of malignancy. Serum IgG4 concentration, measured postoperatively, was elevated in both patients. The characteristic morphological features of AIP are diffuse swelling of the pancreatic parenchyma and diffuse narrowing of the MPD. Recently, a focal type of AIP, which mimics pancreatic carcinoma, has been recognized. Considering the favorable response of AIP to steroid therapy, it is clinically important to differentiate the focal type of AIP from pancreatic carcinoma and to know that AIP sometimes exhibits multiple lesions within the pancreas.     

Autoimmune pancreatitis diagnosed after pancreatoduodenectomy and successfully treated with low-dose steroid

A 69-year-old woman presented with obstructive jaundice and a 30-mm hypoechoic mass in the pancreatic head on ultrasonography. Magnetic resonance imaging (MRI) revealed enlargement of the pancreatic head with dilatation of the upstream main pancreatic duct and no dilatation of the proximal biliary tree. Endoscopic retrograde pancreatography showed a localized irregular narrowing of the main pancreatic duct in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy (PPPD) was performed under the diagnosis of pancreatic head cancer. Histopathological examination showed fibrosis with lymphoplasmacytic infiltration, suggesting the diagnosis of autoimmune pancreatitis (AIP). Serum IgG concentration was within normal limits immediately after the operation but was elevated 4 months later, when MRI showed enlargement of the remnant pancreas, with a peripheral rim of low intensity. Oral administration of prednisolone was initiated, at a dose of 5 mg/day. The serum IgG concentration declined and MRI showed improvement of the pancreatic enlargement and the disappearance of the peripheral rim. AIP has not relapsed for 1 year so far, with the patient being kept on 5 mg/day prednisolone. This communication reports a patient with AIP showing an interesting clinical course.     

Multifocal lesions with pancreatic atrophy in IgG4-related autoimmune pancreatitis: report of a case

We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases.     

胰管结石的手术治疗

目的 探讨胰管结石的手术治疗方式.方法 对1997-2007年间24例胰管结石患者的手术治疗方式进行回顾性分析.结果 24例胰管结石中行胰管纵行切开取石、胰管空肠Roux-en-Y吻合17例,其中附加主胰管外引流2例,附加胆管空肠吻合3例,附加胰腺囊肿空肠吻合1例,1例术后并发胰肠吻合口出血,1例术后早期出现应激性溃疡,均经保守治疗治愈;胰十二指肠切除3例,1例并发吻合口出血,经保守治疗治愈;胰体尾切除2例,保留十二指肠胰头切除1例,胰管切开取石、Ⅰ期缝合1例,术后均无并发症.全组21例得到随访,17例效果优良.结论 胰管纵行切开取石、胰管空肠Roux-en-Y吻合是治疗胰管结石的合理术式,保留十二指肠的胰头切除和胰管切开取石、Ⅰ期缝合用于治疗胰管结石是可行的.     

胰管结石的诊断与外科治疗：附43例报告

目的:探讨胰管结石的诊断及手术治疗方式。方法:回顾性分析6年间进行外科手术的43例胰管结石患者的临床资料。结果:患者男女比例约为2:1,主要症状为上腹痛,部分伴腰背痛。全组均采用影像学检查方法确诊。行胰管切开取石、胰管空肠侧侧Roux-en-Y吻合术34例(其中同时切除胰体尾2例),保留十二指肠的胰头切除术5例,保留幽门的胰十二指肠切除1例,胰十二指肠切除术1例,胰体尾、脾切除1例,探查发现恶变无法切除1例。随访5个月至6年;43例患者中23例腹痛症状完全缓解,18例有不同程度的缓解。结论:影像学检查是确诊胰管结石的主要方法。对胰管结石的手术应制定个体化方案。胰管切开取石,胰管-空肠Roux-en-Y吻合术为胰管结石的主要术式,其他可根据情况采用保留十二指肠的胰头切除术或胰体尾切除等术式。     

Pancreatic transection from blunt abdominal trauma: early versus delayed diagnosis and surgical management

BACKGROUND AND AIMS: Pancreatic trauma is relatively uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. PATIENT MATERIAL: The clinical course and surgical management of 14 patients with distal pancreatic transection or severe laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed in a university teaching hospital. The average age of the 14 patients (12 male, 2 female) was 28.9 years (range 5-56). Six patients had isolated pancreatic trauma, and intra-abdominal and extra-abdominal (mean 0.8) injuries associated with pancreatic transection were seen in the other 8 patients. RESULTS: Nine patients were diagnosed and operated on within the first 24 h. Eight of them underwent transection of the gland with MPD injury; distal pancreatectomy with splenectomy was performed in 3 and without splenectomy in 2, distal pancreatogastrostomy in 1, and - due to associated duodenal laceration and/or contusion of the pancreatic head - pylorus-preserving pancreatoduodenectomy in 2. In 1 case (grade II laceration) only external drainage was necessary. All the patients with early, correctly diagnosed parenchymal and ductal injury survived. Only 1 patient required reoperation due to haemorrhage after pancreatoduodenectomy. The other 5 cases were referred elsewhere after initial treatment, and all of them underwent some kind of external drainage. Three had undetected MPD injury, and in the other 2 cases the parenchymal lesions were either underestimated or missed. All of these cases required subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; 1 patient with MPD injury was lost to follow-up. CONCLUSION: Patients requiring delayed surgical intervention after an unsuccessful period of observation or a subsequent operation due to undetected MPD injury demonstrated a higher rate of pancreas-specific mortality and morbidity.     

胰腺浆液性微囊腺瘤的不典型临床影像特点

目的:探讨胰腺浆液性微囊腺瘤的不典型临床影像表现及诊治策略。方法:回顾2008年7月至2019年10月北京协和医院收治的11例术前临床影像表现不典型的胰腺浆液性微囊腺瘤的患者资料,总结其临床表现、CT/MRI特点、术前临床诊断、手术方法、术后情况等。结果:共纳入11例不典型微囊腺瘤患者,中位年龄50(46～66)岁,女...