摘要
目的分析肿块型慢性胰腺炎的临床和影像学特点，并与胰腺肿瘤相鉴别。方法回顾性分析11例肿块型慢性胰腺炎的临床、影像学、实验室和病理特征。结果肿块型慢性胰腺炎多见于老年人、男性患者，临床主要表现为梗阻性黄疸和腹部不适。血清CA19-9水平可轻度升高，通常〈100U／ml，较胰腺癌低。B超对肿块型CP诊断的准确率仅18．2％，只能作为初筛手段；CT的诊断准确率为45．5％，表现为主胰管及其分支呈球样扩张，可见胰腺假性囊肿和钙化；MRCP和EUS均可见胆总管、胰管不规则扩张，表现与胰腺癌相似；ERCP可清楚显示胰胆管的病变部位、梗阻性质、胰胆管的狭窄及扩张情况等，与CT检查结合，对鉴别肿块型CP与胰头癌有重要意义。根据组织病理检查，少部分肿块型慢性胰腺炎属于自身免疫性胰腺炎。结论肿块型慢性胰腺炎临床和影像学特征与胰腺癌相似，需结合病史、临床表现、实验室及影像学检查、组织病理综合判断。
Objectives To investigate the clinical and imaging features discriminating mass forming chronic pancreatitis （CP） from pancreatic carcinoma. Methods The clinical, radiologic, laboratory and pathologic profiles of eleven patients with mass forming CP were reviewed retrospectively. Results The patients with mass forming CP were predominantly older, male, and presented with obstructive jaundice or abdominal symptoms. Serum level of CA19-9 was slightly elevated, generally below 100 U/ml, which was lower than that of pancreatic carcinoma. The diagnostic accuracy of B-ultrasound for mass forming CP was only 18.2% and it could only be the screening method; the diagnostic accuracy of CT was 45.5%, and the main CT features included dilation of main pancreatic duct and the branches, as well as pancreatic pseudocysts or calcification. The findings of MRCP and EUS were irregular dilation of main pancreatic duct and common bile duct, which were similar to pancreatic carcinoma. ERCP could provide imaging characteristics of biliary and pancreatic duct, and the nature of obstruction, the stricture and dilation of biliary and pancreatic duct. When combined with CT scan, ERCP was useful for differentiation from pancreatic head cancer. According to histopathology, a few mass forming CP was autoimmune pancreatitis. Conclusions Mass forming CP is associated with clinical and radiologic features that are similar to those of pancreatic carcinoma. It is necessary to carefully evaluating clinical and imaging findings, laboratory findings and histopathological examinations.
出处
《中华胰腺病杂志》
CAS
2010年第4期241-244,共4页
Chinese Journal of Pancreatology
关键词
胰腺炎
慢性
胰腺肿瘤
诊断
鉴别
回顾性研究
Pancreatitis, chronic
Pancreatic neoplasms
Diagnosis, differential
Retrospective studies
