胰头部慢性团块型胰腺炎的诊断与治疗策略

目的：探讨胰头部慢性团块型胰腺炎的临床诊断方法与治疗策略。方法：分析2002年5月～2008年10月间我院收治的8例确诊为胰头部慢性团块型胰腺炎患者的临床资料、CT、经内镜逆行胰胆管造影（ERCP）与磁共振胰胆管造影（MRCP）的影像表现,结合治疗效果进行讨论。结果：影像学所见,全部病例的CT影像发现胰头部的低密度肿块;5例患者的ERCP发现胆道明显扩张,3例患者的主胰管扩张,2例十二指肠第二段存在炎性狭窄,活检病理报告为慢性炎症;全部病例MRCP的T1相胰头部肿块为低密度,而T2相则表现为轻度高密度表现。2例行胰十二指肠切除术治疗,3例行胆肠吻合术,2例行内镜逆行乳头括约肌切开取石（EST）＋支架术,随访1～5年,均生存。结论：CT、ERCP与MRCP影像的联合判读是临床诊断慢性团块型胰腺炎的较准确的方法,并为之与胰头癌的鉴别提供帮助。临床上,对于胰头部慢性团块型胰腺炎的治疗应当针对其不同病期所出现的合并症而选择恰当的手术治疗方式。

Diagnosis and treatment strategies of chronic pancreatitis with mass in the head of the pancreas

Objective：To assess the diagnostic procedure and treatment strategies of chronic pancreatitis with mass in the head of the pancreas.Methods：In 8 cases of chronic pancreatitis with mass in the head of the pancreas,CT imaging,endoscopic retrograde cholangiopancreatography（ERCP） and magnetic resonance cholangiopancreatography（MRCP） were performed.The diagnostic accuracy of image analysis and surgical treatment outcomes of these patients were reviewed and evaluated.Results：All cases on CT imagine revealed a hypodense mass and swelling of the pancreatic head,ERCP revealed the biliary system were dilated in 5 cases,and pancreatic head masses were hypointense on T1-weighted images and slight hyperintense on T2-weighted MR images.2 cases were treated with whipple＇s procedure,Roux hepaticojejunos tomy were performed in 3 patients,and in 2 of these cases,endoscopic temporary stents were used,1 case was treated by conservative medical measures.Conclusion：CT,ERCP and MRI are accurate imaging methods for differential diagnosis in patients suffering from chronic pancreatitis with pancreatic head mass and pancreatic head carcinoma.In this situation,if surgery is indicated,the choice of operation must be based on the reason for which treatment had been sought and upon the various morphologic aspects revealed by diagnostic imaging.