胰头部占位性病变CT检查误诊23例分析

目的探讨胰头部占位性病变CT检查误诊原因及鉴别诊断依据。方法对我院2006年4月—2013年5月经病理检查或手术证实CT检查误诊的胰头部占位性病变23例的一般资料及CT检查结果进行回顾性分析。结果本组CT检查肿块型慢性胰腺炎(mass-type chronic pancreatitis,MTCP)误诊为胰头癌12例,胰头癌误诊为MTCP 7例,胰头部结核误诊为胰头癌3例,胰头部钝挫伤误诊为MTCP 1例。1例胰头部钝挫伤行胰头部破裂缝合止血、胰周引流术,1个月后痊愈。7例MTCP及1例胰头部结核行保留十二指肠的胰头切除术,7例胰头癌、5例MTCP及2例胰头部结核行胰十二指肠切除术,其中2例胰头癌和1例胰头部结核行胰十二指肠切除术后3~5 d发生胰漏,经保守治疗痊愈;3例胰头部结核术后给予抗结核治疗,随访2年未再复发;1例胰头癌术后死于多器官功能衰竭;余均痊愈出院。结论详细病史询问、合理运用CT扫描技术、联合其他影像技术、及时进行其他特异性检查,全面收集资料并综合分析可减少胰头部占位性病变的误诊。

Analysis of 23 Misdiagnosed Patients with Pancreatic Head of Space-occupying Lesion by CT Examination

Objective To explore the misdiagnosis causes and differential diagnosis bases of pancreatic head space- occupying lesions by CT examination. Methods Common data and CT examination results of 23 misdiagnosed patients with pancreatic head space-occupying lesions during April 2006 and May 2013, who were confirmed the diagnosis by pathological examinations or surgeries, were retrospectively analyzed. Results Among the 23 patients undergoing CT examination, 12 pa- tients with mass type chronic pancreatitis （MTCP） were misdiagnosed as having carcinoma of head of pancreas, 7 patients with carcinoma of head of pancreas were misdiagnosed as having MTCP, 3 patients with pancreatic head tuberculosis were mis- diagnosed as having carcinoma of head of pancreas, and 1 pancreatic head of blunt trauma was misdiagnosed as having MTCP. The patient with pancreatic head of blunt trauma received pancreatic head of suture hemostasis and pancreatic drainage, and the patient recovered 1 month later. Seven patients with MTCP and one with pancreatic head tuberculosis underwent resection of pancreatic head with remaining duodenum ; 7 patients with carcinoma of head of pancreas, 5 with MTCP and 2 with pancre- atic head tuberculosis underwent pancreaticoduodenectomy, in whom 2 patients with carcinoma of head of pancreas and 1 pa- tient with pancreatic head tuberculosis had pancreatic leakage 3-5 d after the pancreaticoduodenectomy, and were cured by conservative treatment; 3 patients with pancreatic head tuberculosis were treated with anti tuberculosis treatment after the oper- ation, and there was no recurrence in the followed up for 2 years; 1 with pancreatic cancer died of multiple organ failure after the operation; the others were cured and were discharged. Conclusion The misdiagnosis rate of space-occupying lesions of the head of pancreas may be reduced by detailed history, the reasonable use of CT scanning, combined with other imaging techniques, other specific inspection techniques and collecting all-sided data and comprehensive analysis of data.