64例胰头部肿块的诊断与鉴别

目的：总结分析胰头肿块型慢性胰腺炎和胰头癌的诊断与鉴别.方法：回顾分析中日友好医院1998年7月～2003年1月间病理明确诊断的64例胰头肿块患者的临床特点及影像学表现.结果：64例中胰头癌40例,胰头肿块型慢性胰腺炎24例,均以腹痛、黄疸、体重下降为主要表现.41例检测了CA199,胰头癌组28例,其中23例＞100U/dl;慢性胰腺炎组13例均＜100 U/dl,其中2例＞20 U/dl.所有病例术前均行B超检查,诊断符合率：胰头癌组为85%（34/40）,慢性胰腺炎组为33.3%（8/24）;内镜逆行胰胆管造影检查诊断符合率：胰头癌组为92.3%（12/13）,慢性胰腺炎组为81.8%（9/11）.结论：综合分析临床特点、实验室检查及影像学改变可提高胰头肿块患者的确诊率.

Diagnosis and differential diagnosis of mass in head of pancreas:reports of 64 cases

Objective:To analyze the diagnosis and differential diagnosis between chronic pancreatitis with mass in head of pancreas and cancer of head of pancreas.Methods:Sixty-four cases mass in head of pancreas in our hospital from July 1988 to January 2003 which were diagnosed definitely by pathology and surgery were reviewed.The clinical features and imaging data were summarized.Results:There were 40 cases of cancer of head of pancreas and 24 cases of chronic pancreatitis with mass in head of pancreas.The mainly clinical features included abdominal pain,jaundice and loss of weight.CA199 were tested in 41 cases,including cancer of head of pancreas(28 cases,23 cases over 100U/dl) and chronic pancreatitis(13 cases,2 cases over 20 U/dl but under 100U/dl).B mode ultrasonography were examined in all patients.Among them,85% of cancer of head of pancreas groups and 33.3% of chronic pancreatitis groups were correctly diagnosed.Thirteen cases of cancer of head of pancreas groups undergone ERCP before surgery and 9 cases of chronic pancreatitis groups were correctly diagnosed by ERCP.Conclusion:Diagnoses can be more accurate by careful analysing the clinical features,laboratory results and imaging changes.