慢性胰腺炎的诊治策略

慢性胰腺炎临床并不少见,为各种病因引起的胰腺组织和功能不可逆的慢性炎症性疾病,其病理特征为胰腺腺泡萎缩、破坏和间质纤维化.其早期临床症状为反复发作的上腹部疼痛或胰腺炎,进展期可合并胰腺外、内分泌功能不全的症状.影像学上表现为胰腺实质钙化、胰管扩张、胰管结石和胰腺假性囊肿形成等.而大量流行病学研究表明,慢性胰腺炎是胰腺癌的高危因素.     

慢性胰腺炎治疗中外科手术的选择

慢性胰腺炎(chronic pancreatitis,CP)是指由不同病因引起的胰腺实质弥漫性或局限性病理改变,临床上可表现为持续性腹痛,进行性的内、外分泌功能减退。影像学检查可发现胰管狭窄、扩张、胰管结石、胰腺钙化、胰腺假性囊肿、胰腺包块等。治疗目的主要是缓解疼痛,解除胆胰管梗阻,清除结石,切除肿大的胰腺包块,延缓病程,补充胰腺内、     

慢性胰腺炎的CT表现对治疗选择的意义

目的探讨慢性胰腺炎CT形态学分型及其对治疗选择的指导作用。方法回顾分析经治疗证实的59例慢性胰腺炎的CT影像和治疗方法，结合文献总结讨论不同病理形态改变的慢性胰腺炎在治疗方法选择上的区别。结果59例中27例（46％）表现为全胰腺萎缩伴不同程度胰实质钙化，采取内科保守治疗：7例为单或多发囊肿型（12％）表现为胰腺及其周围多发假性囊肿形成，对最长径大于5cm者行切开引流和吻合：7例（12％）表现为胰管狭窄或扩张，行胰管减压引流术；5例（8％）为表现为胰头胰腺局限性软组织样肿块，全部手术切除。13例（22％）为以上两种或以上的混合表现，以外科手术为主。对合并有胆道梗阻的病例做减压引流。结论慢性胰腺炎可分萎缩钙化型、假性囊肿型、胰管狭窄或扩张型、肿块型、混合型5型，CT形态学分型对治疗方案选择及明确病因有一定的意义。     

慢性胰腺炎78例诊断和外科治疗

目的探讨慢性胰腺炎的临床诊断,评价慢性胰腺炎的手术疗效。方法回顾性临床资料分析。结果慢性胰腺炎的临床诊断正确率78.2%(61/78),误诊17例,其中真性囊肿误诊为假性囊肿8例,胰腺壶腹部癌误诊为慢性胰腺炎6例。手术方法包括胰十二指肠切除术12例,胰体尾或囊肿切除术27例,胰腺囊肿空肠Roux-en-Y吻合术8例,胰管空肠Roux-en-Y吻合术2例,胰腺囊肿外引流4例,胰床引流3例,胰腺活组织学检查22例。疗效:手术后腹痛缓解率65.6%(40/61),腹痛缓解明显42.6%(26/61),腹痛缓解不明显23.0%(14/61);腹痛不缓解率32.8%(20/61);手术死亡率1.64%(1/61)。结论病理组织学诊断是慢性胰腺炎诊断的金标准;慢性胰腺炎可发生局限性癌变;慢性胰腺炎临床表现复杂,外科治疗应采用个体化原则。     

114例慢性胰腺炎的临床分析

目的 探讨慢性胰腺炎的诊治方法。方法 对1997年5月至2002年11月期间所收治并经临床或病理证实的114例慢性胰腺炎患者的资料进行回顾性分析。结果 主要临床表现为腹痛、体重下降、腹胀和消化不良。影像学特征为胰腺肿块、假性囊肿、胰管扩张和胰管结石。本组中有60例行外科手术治疗．术后发生并发症4例，死亡1例，其余54例经保守治疗症状缓解。结论 慢性胰腺炎临床表现和影像学表现变化多样，应根据病变特点选择手术方式。     

主胰管解剖学可助于选择假性囊肿的治疗方法(手术或经皮引流)

胰腺假性囊肿有的可行消退 ,有的可经手术或经皮引流治愈 ,这与主胰管的解剖学有关。作者分析Texas大学医学部外科于 1985～ 2 0 0 0年所收治的 2 5 3例胰腺假性囊肿均经超声、CT或 MRCP检查确诊。共作 ERCP以显主胰管形态 ,分成 : 型 ,正常 ,与囊肿无沟通 ; 型 ,胰管正常 ,但与囊肿沟通 ; 型 ,胰管有狭窄 ,与囊肿不沟通 ; 型 ,胰管有狭窄 ,与囊肿沟通 ; 型 ,部分胰管不显影 ; 型 ,胰管扩张而扭曲 ,不与囊肿沟通 (为慢性胰腺炎表现 ) ; 型 ,同 型 ,但与囊肿沟通。全组中 ,男性 187例 ,女性 6 6例 ,平均年龄 4 6±4 .1岁。胰腺炎病因属…     

胰腺癌的超声误漏诊原因分析及其对策

目的 探讨胰腺癌的超声误漏诊原因及其对策。 方法 回顾我院近10年来胰腺癌病例203例,对其超声检查结果进行分析,寻找超声误漏诊原因及其对策。结果 203例胰腺癌中,超声诊断胰腺癌132例,诊断符合率为65%。漏诊53例,其中4例提示胰腺局部增大,4例仅提示为主胰管扩张,4例提示胰腺回声改变,而均未发现胰腺肿瘤;18例因肠道气体干扰致胰腺显示不清,23例超声提示为胰腺正常而漏诊。误诊18例,其中2例提示胰腺增大伴主胰管不规则扩张而误诊为慢性胰腺炎,4例误诊为壶腹癌,3例误诊为胆总管肿瘤,3例胰尾癌误诊为左肾上腺占位,6例诊断为后腹膜包块而未能与腹膜后其他肿瘤相鉴别。结论 超声对胰腺癌的诊断有一定价值,超声造影有助于发现较小的胰腺癌病灶,但需结合临床病史特点、实验室检查及其他影像学检查结果以进一步提高对胰腺癌的诊断。     

慢性胰腺炎的手术适应证和术式选择

目的提高慢性胰腺炎的外科治疗效果. 方法回顾性总结分析55例慢性胰腺炎外科治疗资料.发病因素:嗜酒5年以上、胆系结石、急性胰腺炎病史分别占38.2%,29.1%和20.0%.主要临床表现:慢性腹痛、梗阻性黄疸、体重减轻、消化不良、糖尿病分别为98.2%,38.2%,34.5%,20.0%和10.9%.全组均因慢性腹痛或伴有胰管和(/或)胆管梗阻、结石、胰腺钙化、肿块、假性囊肿等行外科治疗,共采用了10种术式. 结果无手术死亡和严重并发症.术后效果良好43例(78.2%),症状减轻好转10例(18.2%),无效2例(3.6%). 结论慢性胰腺炎长期慢性腹痛并胰胆管梗阻、结石、肿块、假性囊肿适于外科治疗,应根据病变类型和特点选择不同的术式.胰管梗阻扩张、结石或假性囊肿宜行胰管或囊肿空肠吻合,胰头肿块并胆、胰管梗阻可行胰头十二指肠切除或胆胰管空肠吻合术.     

胰腺巨大假性囊肿27例的外科治疗

目的 探讨巨大胰腺假性囊肿的临床特点,并对各种外科治疗方法进行评价.方法 对1991年2月至2008年2月收治的27例巨大胰腺假性囊肿(长径>10cm)的临床资料进行回顾性分析.结果 27例巨大胰腺假性囊肿约占同期全部胰腺假性囊肿的20.9%;病因分类:急性胰腺炎所致占51.9%,胰腺外伤和手术所致占33.3%,慢性胰腺炎所致占11.1%;病程小于6周者占绝大多数(21/27);30%患者出现上消化道梗阻(8/27);影像学上虽然囊肿巨大,但均为单房囊肿;ERCP检查发现多数囊肿与胰管相通(9/11).手术方式包括囊肿外引流术9例,均失败,改行其他内引流术.囊肿胃吻合术10例,1例失败,改行囊肿空肠引流术,ERCP胰腺导管囊肿内支架引流术2例,1例失败,改行囊肿空肠引流术,囊肿空肠Roux-en-Y吻合术17例(其中11例为采用其他手术方式治疗失败者).所有患者均临床治愈.结论 胰腺巨大假性囊肿多数出现胰管解剖学改变,外科治疗时机和适应证有别于一般性胰腺假性囊肿.     

慢性胰腺炎诊治进展

<正>慢性胰腺炎(Chronic Pancreatitis,CP)是一种胰腺实质反复发作炎症,导致胰腺纤维化形成和渐进性结构功能损毁的疾病。临床早期典型表现为慢性腹痛、反复发作胰腺炎及相关并发症,进展期表现为胰腺外分泌和内分泌功能逐渐丧失[1],CP的主要症状为慢性腹痛、消化不良和糖尿病。主要并发症则包括:胰腺假性囊肿;胰管结石/狭窄;十二指肠狭窄;血管并发症;胆管梗阻;营养不良;胰腺癌;慢性     

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??CT and MRI manifestations of pancreatitis misdiagnosed as pancreatic cancer SU Tao*??WANG Jian??JIN Han-tao??et al. *Department of Emergency??Center Hospital of Xuhui District??Shanghai 200031??China
Corresponding author : WANG Jian ??E-mail??wangjian_su@yahoo.com.cn
Abstract Objective To research the key points in differential diagnosis of pancreatitis and pancreatic cancer. Methods The imaging data of 22 cases of pancreatitis misdiagnosed as pancreatic cancer between 2001 and 2010 at Changzheng Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Results Manifestations of pancreatitis misdiagnosed as localized pancreatic cancer were pseudotumorous pancreatitis of pancreatic head or pancreatic body??pancreatic necrosis and pseudocyst??inhomogeneous lipidosis??retentive extension of pancreatic duct due to pancreas divisum and accumulation of blood in pancreatic duct due to pancreas divisum. Misdiagnosed as disseminated pancreatic cancer were disseminated enlargement of pancreas with inhomogeneous density, lesser blood supply lesion and pancreatitis without effusion. Misdiagnosed as metastases outside pancreas were parapancreatic pseudocysts or inflammatory mass misdiagnosed as metastatic lymph nodes. Accessory lesions of superior mesenteric vein and splenic vein misdiagnosed as vascular invasions. Conclusion Diagnosis of atypical pancreatic cancer should be based on a comprehensive knowledge of medical history and weekly follow-ups so as to exclude the possibility of atypical pancreatitis. As for patients who have both pancreatitis and pancreatic cancer??treatments of pancreatitis with therapeutic values should always be emphasized regardless of the pancreatic cancer.     

Autoimmune pancreatitis

BACKGROUND: Approximately 2 per cent of pancreatic masses resected for suspected malignancy are found instead to be a form of chronic pancreatitis defined by a characteristic lymphoplasmacytic infiltrate. This condition is now commonly classified as 'autoimmune pancreatitis'. METHODS: A literature review of autoimmune pancreatitis was performed using Medline and PubMed. The reference lists of identified articles were searched for further relevant publications. RESULTS: Patients are predominantly 55-65 years old and present with obstructive jaundice, abdominal pain and weight loss. Imaging may show a mass of malignant appearance or pancreatobiliary tree strictures precipitating surgical exploration. Raised serum levels of IgG4 and specific autoantibodies, when combined with particular radiological features and a biopsy negative for malignancy, enable a preoperative diagnosis and successful treatment with steroids. CONCLUSION: Autoimmune pancreatitis is not uncommon and steroid treatment can effect a dramatic improvement. Care is needed to ensure that pancreatic cancer is not misdiagnosed.     

超声检查鉴别诊断胰腺癌与局限性胰腺炎的价值

目的：探讨超声检查鉴别诊断胰腺癌与局限性胰腺炎的价值。方法：回顾性分析经手术和病理证实的胰腺癌30例和局限性胰腺炎18例的超声声像图特征，分析超声检查对鉴别诊断的价值。结果：胰腺癌和局限性胰腺炎在患者年龄、胰腺肿块内有无胰管结构、肿块内有无强回声斑块、肿块后方回声等方面均有显著性差异。患者年龄较轻，肿块内有胰管结构、强回声斑块及肿块后方回声增强提示多为局限性胰腺炎。结论：超声检查对鉴别诊断胰腺癌和局限性胰腺炎有一定的价值。     

胰腺癌患者外周血中黏附分子水平检测及其临床意义

目的 探讨胰腺癌患者外周血中内皮细胞选择素（E-selectin）、血小板选择蛋白（P-selection）、细胞间黏附分子-1（ICAM）、血管细胞间黏附分子-1（VCAM）、活化白细胞细胞黏附分子（ALCAM）的检测水平及其临床意义。方法 选择2014年4月至2015年8月期间我院普外科收治的40例胰腺癌患者（胰腺癌组）作为研究对象,其中淋巴结浸润14例,伴肝转移11例;临床分期I~II期24例,III~IV期16例。选择同期胰腺炎患者40例（胰腺炎组）、健康体检者40例（对照组）进行比较。采用ELISA法检测ICAM、VCAM、E-selectin、P-selection、ALCAM水平。结果 胰腺癌组ICAM、VCAM、E-selectin、ALCAM水平高于胰腺炎组和对照组,胰腺炎组高于对照组,差异均有统计学意义（P<0.05）;胰腺癌组P-selection水平低于胰腺炎组和对照组,胰腺炎组低于对照组,差异均有统计学意义（P<0.05）。III~IV期胰腺癌患者ICAM、VCAM、E-selectin、ALCAM水平高于I~II期者,差异有统计学意义（P<0.05）;III~IV期胰腺癌患者P-selection水平低于I~II期者,差异有统计学意义（P<0.05）。胰腺癌伴淋巴结浸润患者ICAM、VCAM、E-selectin、ALCAM水平高于不伴淋巴结浸润者,差异有统计学意义（P<0.05）;胰腺癌伴淋巴结浸润患者P-selection水平低于不伴淋巴结浸润者,差异有统计学意义（P<0.05）。胰腺癌伴肝转移患者ICAM、VCAM、E-selectin、ALCAM水平高于不伴肝转移者,差异有统计学意义（P<0.05）;胰腺癌伴肝转移患者P-selection水平低于不伴肝转移者,差异有统计学意义（P<0.05）。结论 胰腺癌患者存在血管内皮功能的紊乱,且血管内皮功能紊乱与胰腺癌的临床病理有关。     

胰腺癌MUC4的表达及其临床相关影响因素的分析

目的:研究胰腺癌组织中MUC4的表达及其与临床相关因素间的关系。方法:采用免疫组织化学法检测53例胰腺导管腺癌和对应癌旁组织,以及9例慢性胰腺炎组织MUC4的表达,分析胰腺癌MUC4的表达与肿瘤分化、分期、病人生存时间等临床因素之间的关系。结果:53例胰腺癌组织中MUC4蛋白阳性表达43例(81.1%),对应癌旁组织中MUC4蛋白均为阴性表达,9例慢性胰腺炎中MUC4蛋白阳性表达2例(22.2%)。MUC4蛋白在胰腺癌组织中阳性表达率显著高于癌旁组织及慢性胰腺炎组织(P0.05)。单因素及多因素生存分析显示,淋巴结转移、临床TNM分期和MUC4的表达是胰腺癌预后相关的重要独立因素,MUC4的高表达组预后较差(P<0.05)。结论:MUC4可能是一个特异的胰腺癌肿瘤相关标志物,在胰腺癌中有较高的表达率,MUC4的检测有助于胰腺癌的诊断,并可作为鉴别胰腺癌和慢性胰腺炎的一个重要参考指标;同时MUC4的检测还有助于判断手术病人的预后。     

Chronic pancreatitis with synchronous and metachronous malignancy: three unusual cases and a literature review

HYPOTHESIS: Chronic pancreatitis is a risk factor for pancreatic cancer. The association between these 2 disease processes is not well known. We present 3 unusual cases of pancreatitis associated with pancreatic cancer and review the possible mechanisms that can cause pancreatitis to degenerate into pancreatic cancer. DESIGN: A case series reviewing 3 unusual cases of chronic pancreatitis associated with pancreatic cancer. The patients' charts are reviewed, and a literature search is performed looking for chronic pancreatitis associated with pancreatic cancer. SETTING: The cases were performed at a small community hospital in New York City, New York. PARTICIPANTS: The surgeons involved are experienced pancreatic surgeons with a large referral group. The endoscopies were performed by gastroenterologists with years of experience in biliary and pancreatic disease. RESULTS: The cases and the literature review support the hypothesis that there is an association between chronic pancreatitis and pancreatic cancer. CONCLUSIONS: Three unusual case of chronic pancreatitis, 2 with synchronous and 1 with metachronous malignancies, are presented. The pathway of benign to malignant change is reviewed, and the constant awareness that pancreatitis is associated with malignancy must be kept in mind.     

Endoscopic measurement of pancreatic juice secretory flow rates and pancreatic secretory pressures after secretin administration in human controls and in patients with acute relapsing pancreatitis,chronic pancreatitis,and pancreatic cancer

Secretory flow rates were measured inside the main pancreatic duct during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer and in controls after intravenous administration of secretin. Peak secretory flow rates in these groups were 5.04 ± 1.74, 0.71 ± 1.28, 0.60 ± 1.37, and 4.13 ± 0.88 ml/min, respectively. Peak secretory pressures were also measured intraductally in patients with acute relapsing pancreatitis and pancreatic cancer and in controls and were 402 ± 69, 75 ± 161, and 403 ± 99 mm pancreatic juice, respectively. Peak secretory flow rates and pressures measured in controls during constant administration of secretin were similar to those measured when secretin was administered as a bolus.     

RCAS1在胰腺癌诊断中的作用

目的 评价SiSo细胞表达的受体结合癌抗原(RCAS1)在胰腺癌诊断中的作用.方法 应用酶联免疫吸附分析法检测46例胰腺癌患者、18例慢性胰腺炎患者和20名健康人血清中RCAS1、CA19-9和CA242的含量.用ROC曲线法对检测结果进行分析.应用免疫组织化学染色法对32例胰腺癌、10例慢性胰腺炎以及6例正常胰腺组织切片进行染色,观察RCAS1在胰腺癌和正常胰腺组织中的表达情况.同时对结果进行统计学分析.结果 3种肿瘤标志物的水在胰腺癌组均高于慢性胰腺炎组和正常对照组,且差异均有统计学意义(P＜0.01).运用ROC曲线法对3种肿瘤标志物的检测结果进行处理.RCAS1、CA19-9和CA242的曲线下面积分别为0.826、0.804和0.737.分层分析表明,RCAS1和CA19-9在有梗阻性黄疸组高于无梗阻性黄疸组(P＜0.01),CA19-9在手术无法切除组高于手术可切除组(P＜0.01).胰腺癌组织中RCAS1表达的阳性率为87.5%,慢性胰腺炎组织为40.0%,两组差异有统计学意义(P＜0.05).结论 RCAS1在胰腺癌组织中高表达,作为血清肿瘤标志物对胰腺癌的综合诊断能力优于CA19-9和CA242,若同时联合检测CA19-9,则对提高胰腺癌早期诊断和术前可切除性评估准确率有一定的临床价值.