23例胰头肿块型胰腺炎的诊治分析

目的 总结分析胰头肿块型胰腺炎的诊断和治疗方法。方法 回顾性分析我院1983年5月至2001年10月收治的245例慢性胰腺炎病例，总结其中23例因胰头上位术前难以与胰腺癌进行鉴别而行胰十二指肠切除术病人的病例资料。结果 本组中有饮酒史者16例，慢性胆囊炎史5例，特发性1例，工作中长期接触有毒气体者1例。因梗阻性黄疸入院者14例，另9例因主诉腹痛入院，病程小于2年者19例，大于2年者14例。诊断方法包括肿瘤标记物，B超，CT，ERCP和血管造影。23例病人术中探查均显示肿物位于胰头，与周围组织粘连严重，其中3例与门静脉有粘连，但尚能剥离，而术后病理均为慢性胰腺炎。结论 目前尚无特异性好和敏感性高的有效鉴别诊断方法区分慢性胰腺炎与胰腺癌，分子生物学进展对此有一定帮助，增强CT结合ERCP对大部分病例的鉴别诊断具有较高的价值。由于酒精性胰腺炎已经被认为是癌前病变，对于胰头肿块型胰腺炎行胰十二指肠切除术已经逐渐被接受。

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

Objective To summarize the experience of our hospital in diagnosis and treatment of chronic pancreatitis (CP) with mass in head of pancreas. Methods A total of 245 patients with CP treated in our hospital from May 1983 to October 2001 were reviewed. Twenty three of them received Whipple procedure because of difficult preoperative differential diagnosis between pancreatic cancer and CP. Results The etiological factors in these group of patients were alcohol consumption (16), chronic cholecystitis (5), idiopathic pancreatitis (1) and long term poison contact (1). Before admission, 14 patients complained about obstructive jaundice and the other 9 abdominal pain. The diagnostic methods included serological marker determination, B mode ultrasonography, CT, ERCP and angiography. The exploration showed that the mass was located in the head of the pancreas. Twenty three patients had severe around tissue adhesion and 3 single adhesion with vena portae. Pathological examination indicated that 23 patients suffered from CP. Conclusions There is limitation to differentiate the two diseases. The progression of molecular biology may help a lot. ERCP in combination with CT is the most sensitive method for distinguishing a neoplasm from CP. Since alcohol induced CP has been accepted as a pancreatic precancerous lesion, Whipple procedure is a good approach for its treatment.