伴梗阻性黄疸的慢性胰腺炎的诊断与处理

目的 探讨以非结石性梗阻性黄疸为主诉之慢性胰腺炎的诊治原则。方法 对1985年1月至2004年12月20例以非结石性梗阻性黄疸为主诉慢性胰腺炎的临床特点及诊治过程进行回顾分析。结果 （1）本组病例以黄疸为主诉,90．0％无典型慢性胰腺炎临床表现及影像特征,胰内段胆总管狭窄是特征性影像表现。（2）病理诊断为弥漫性胰腺慢性炎症。（3）CT、Bus、Eus、ERCP、MRCP及肿瘤标志抗原检测仅在一定程度上提供诊断鉴别依据;超声引导细胞（1例）或组织（1例）穿刺及术中探查并多部位组织学穿刺（14例）可提供确切诊断。（4）选择Oddi括约肌成形术（2例）和胆肠吻合术（18例）后,胆道引流效果稳定。结论 以梗阻性黄疸为主诉之慢性胰腺炎占同期住院慢性胰腺炎病例的15.0％;该梗阻性黄疸由胰腺炎症造成,应与全胰腺癌鉴别;术前检查仅可有限提供鉴别诊断资料,术中探查并多部位组织学穿刺可提供病理诊断;胆囊空肠或胆总管空肠吻合术是安全、经济的治疗措施,在无胰管病变时无须胰管引流手术;远期预后及胰腺病变转归尚待评估。

The diagnosis and treatment for chronic pancreatitis complicated by non-calculous obstructive jaundice

OBJECTIVE: To study the characters of chronic pancreatitis complicated by non-calculous obstructive jaundice, and discuss the methods for differentiation and treatment. METHOD: Twenty cases selected from January 1985 to December 2004 were analysed in the fields of differentiation and treatment. RESULTS: All cases didn't present with typical clinical presentations and radiological features. Jaundice was presented as the main complaint. Stricture of the intra-pancreatic common bile duct was the symbolic radiological feature. Pancreatic disseminated inflammation was verified pathologically in these cases. CT, ultrasound, EUS, ERCP, MRCP and antigen-marker of neoplasm failed to offer the data for differentiation. The diagnosis could only be determined by pathological exam. The obstructive jaundice could be solved by biliary-enteric anastomoses successfully. CONCLUSIONS: The patients with sole complaint of obstructive jaundice account for 15% of all inpatients with chronic pancreatitis. There exists a direct relationship between the jaundice and the pancreatic inflammation. This disorder should be differentiated from total pancreatic carcinoma, but few differentiated material could be offered by preoperative studies. Pathological result derived from the tissue sample obtained within the exploration would be reliable for diagnosis. The bypass between biliary tract and intestine would be a safe and economical treatment method.