自身免疫性胰腺炎的诊治分析：附2例报告

背景与目的 自身免疫性胰腺炎（AIP）是一种由自身免疫介导的罕见胰腺炎，发病率约10.1/10万，皮质激素治疗效果良好。但部分局灶性AIP与胰腺癌较难鉴别，也存在误诊为胰腺癌而采取手术治疗的情况。目前，AIP的发病机制尚未阐明，相关研究仍然缺乏。本文报告本中心近期收治的2例1型AIP患者的诊治过程，并结合文献进行复习以期为临床工作提供借鉴。方法 回顾性分析中南大学湘雅三医院胆胰外科收治的2例1型AIP患者的临床资料，并复习相关文献，对该病的临床特点和治疗决策进行分析总结。结果 2例患者均为男性，表现为梗阻性黄疸，影像学检查均提示胰头部占位，难以区分炎症及肿瘤。患者1血IgG4显著升高，伴有胰腺外器官受累的表现，诊断为1型AIP，激素治疗后病情缓解。患者2相对不典型，无血IgG4和胰外器官受累等表现，超声内镜穿刺病理回报慢性炎症，为进一步诊治行腹腔镜下胰十二指肠切除术，术中可见胰头明显肿大，质地硬，与周围粘连紧密。术后病理呈典型的淋巴浆细胞硬化性胰腺炎（LPSP），诊断为1型AIP，激素治疗后病情缓解。结论 对于胰腺占位可疑胰腺恶性肿瘤的患者，要时刻考虑到AIP的可能，完善免疫标志物等检查。典型病例一般诊断不难，而不典型病例则可能需要手术切除后才能最终诊断，对于中老年男性、肿瘤标志物正常或轻度升高、穿刺病理阴性的患者，良性占位的可能性大，应密切关注术后病理，如诊断为AIP，需告知患者尽早接受规范的内科治疗。

Analysis of diagnosis and treatment for autoimmune pancreatitis: a report of 2 cases

Background and Aims Autoimmune pancreatitis (AIP) is a rare form pancreatitis caused by an autoimmune process with an incidence of about 10.1/100 000, and a positive response to steroids. However, it is difficult to distinguish focal AIP from pancreatic cancer, and there have been cases of misdiagnosis as pancreatic cancer leading to surgical treatment. Currently, the pathogenesis of AIP is unclear, and there is still a lack of relevant research. This article reports the diagnosis and treatment process of two cases of type 1 AIP recently admitted to our center, and additionally reviews the relevant literature in order to provide a useful reference for clinical work.Methods The clinical data of two patients with type 1 AIP admitted to the Department of Hepatobiliary and Pancreatic Surgery at the Third Xiangya Hospital of Central South University were retrospectively analyzed, combined with review of the relevant literature. The clinical characteristics and treatment decisions of this disease were analyzed and summarized.Results Both patients were male and presented with obstructive jaundice. Imaging examinations showed a mass in the pancreatic head, which was difficult to distinguish between inflammation and tumor. Case 1 had significantly elevated blood IgG4 level and extrapancreatic organ involvement, and was diagnosed with type 1 AIP. The patient''s condition improved after steroid treatment. Case 2 was relatively atypical, with no blood IgG4 elevation or extrapancreatic organ involvement. Pathological examination of the ultrasound-guided fine-needle aspiration biopsy showed chronic inflammation, and further diagnosis and treatment were performed with laparoscopic pancreaticoduodenectomy. During the surgery, the pancreatic head was found to be significantly enlarged, hard in texture, and closely adhered to the surrounding tissues. Postoperative pathology revealed typical lymphoplasmacytic sclerosing pancreatitis (LPSP), and the patient was diagnosed with type 1 AIP. The patient''s condition improved after steroid treatment.Conclusion For patients with pancreatic mass suspicious for pancreatic malignancy, the possibility of AIP should always be considered, and immunological markers and other examinations should be perfected. Typical cases are generally easy to diagnose, while atypical cases may require surgical resection before a final diagnosis can be made. For middle-aged and elderly men with normal or slightly elevated tumor markers and negative puncture pathology, the possibility of benign lesions is high, and postoperative pathology should be closely monitored. If the diagnosis of AIP is made, patients should be informed to receive standardized medical treatment as soon as possible.