摘要
目的 总结首发症状为急慢性胰腺炎的胰腺癌的诊断与治疗经验.方法 回顾性分析2003年1月至2014年6月大连医科大学附属第一医院和大连医科大学附属中心医院收治的13例以急慢性胰腺炎为首发症状的胰腺癌患者的临床资料.患者术前行实验室和影像学检查,术前根据肿瘤部位、进展程度和患者意愿决定治疗方案.治疗方法包括手术、放疗、化疗或其他对症支持治疗.手术患者术中及术后行病理学检查.通过电话随访患者出院后生存情况,随访时间截至2014年7月.结果 13例患者表现为腹痛,7例表现为腰背痛.7例患者体质量下降.13例患者均无胰腺癌家族史.13例患者中1例拒绝采血化验,12例患者血清CA19-9值升高（其中11例＞1×10^5 U/L）,5例患者血清CEA升高.13例患者均行腹部CT平扫或增强扫描,3例患者行MRI检查,3例患者行超声检查.肿瘤位于胰头部9例、胰颈部2例、胰尾部2例.肿瘤大小为1.7 cm×1.7 cm～4.9 cm ×4.8 cm.7例患者见胆总管、肝内胆管、胰管扩张.3例患者肿瘤侵犯肠系膜上静脉.腹腔内淋巴结明显肿大者4例,腹腔积液者3例.CT检查证实胆囊结石2例,MRCP检查证实胆总管结石1例.超声检查均提示胰腺体积增大,其中2例提示主胰管扩张.10例患者经影像学检查排除腹腔其他部位恶性肿瘤证实为胰腺癌晚期.依据影像学进行分期,临床分期为Ⅱ期5例、Ⅳ期8例.2例患者行胰十二指肠切除术,其中1例术后行放化疗.1例患者行姑息性胆肠吻合＋胃空肠吻合术.10例非手术患者中1例施行放疗,2例施行化疗,其余7例患者采取对症支持治疗.2例行胰十二指肠切除患者的病理学检查结果均为中、低分化腺癌,瘤体大小分别为4.0 cm ×3.0 cm×2.5 cm和2.5 cm×2.0cm×1.0cm.13例患者中3例失访.慢性胰腺炎为首发症状的患者生存时间为0.5 ～10.0个月,中位生存时间为3.0个月.急性胰腺炎为首发症状的患者生存时间为2.0 ～6.0个月,中位生存时间为4.5个月.4例CEA升高的患者,出院后平均生存时间为3.5个月,5例CEA未升高的患者出院后平均生存时间为5.4个月.10例随访患者在随访期内均因胰腺肿瘤转移或复发死亡.结论 首发症状为急慢性胰腺炎的胰腺癌临床症状不典型,早期诊断较为困难,确诊时多为晚期,预后较差.联合实验室和影像学检查,并依据病情变化动态追踪可提高诊断的准确性.治疗采用以外科手术为主的综合治疗.
Objective To investigate the diagnosis and treatment of pancreatic carcinoma with acute and chronic pancreatitis as the initial symptoms.Methods The clinical data of 13 patients with pancreatic carcinoma who were admitted to the First Affiliated Hospital of Dalian Medical University and the Affiliated Central Hospital of Dalian Medical University from January 2003 to June 2014 were retrospectively analyzed.The first symptoms were acute and chronic pancreatitis.Laboratory and imaging examinations were carried out on all the patients,and the treatment plan was designed according to the location and stage of the tumor as well as the patient＇s wishes.Surgery,radiotherapy,chemotherapy and other symptomatic treatment were selected.All the patients were followed up by telephone interview till July 2014.Results The major symptoms included abdominal pain and lumbodorsal pain （7 patients）.Of the 13 patients,1 patient refused to received laboratory examination,and the levels of CA19-9 of the other 12 patients were elevated （the levels of CA19-9 of 11 patients were above 1 × 10^5 U/L）.The levels of carcinoembryonic antigen （CEA） of 5 patients were elevated.Thirteen patients received plain or enhanced abdominal computed tomography （CT）,3 received magnetic resonance imaging （MRI） and 3 received sonography.The tumors located at the head of the pancreas wcrc observed in 9 patients,tumors located at the neck of the pancreas was observed in 2 patients,and tumors located at the tail of the pancreas were observed in 2 patients.The sizes of the tumors ranged between 1.7 cm × 1.7 cm and 4.9 cm × 4.8 cm.The common bile duct,intrahepatic bile duct and pancreatic duct of 7 patients were dilated.The superior mesenteric vein of 3 patients were invaded by the tumor.The lymph nodes of 4 patients were swollen,and 3 patients had peritoneal effusion.The results of CT confirmed that 2 patients were with cholecystolithiasis,and the results of magnetic retrograde cholangiopancreatography （MRCP） confirmed that 1 patient had choledocholithiasis.The size of he pancreas of all the patients were increased using ultrasonography,and the main pancreatic ducts of 2 patients were dilated.Ten patients were diagnosed as with advanced pancreatic carcinoma.All the patients were staged by the imaging findings,5 patients belonged to stage Ⅱ and 8 belonged to stage Ⅳ.Two patients underwent pancreaticoduodenectomy,and 1 of them underwent postoperative radiotherapy and chemotherapy,and the other patient underwent palliative biliary enteric anastomosis and gastrojejunostomy.Two patients were treated by chemotherapy and 1 by radiotherapy in the 10 patients who did not received surgery.The rest 7 patients were treated with symptomatic therapy.The pathological results of the 2 patients who underwent pancreaticoduodenectomy were both moderately and poor-differentiated adenocarcinoma,and the size of the tumors were 4.0 cm × 3.0 cm × 2.5 cm and 2.5 cm × 2.0 cm × 1.0 cm.Three patients lost to follow-up among the 13 patients.The survival time of the patients with acute pancreatitis as the initial symptom ranged from 2.0 months to 6.0 months,and the median survival time was 4.5 months.The survival time of the patients with chronic pancreatitis as the initial symptom ranged from 0.5 months to 10.0 months,and the median survival time was 3.0 months.The median survival time of the 4 patients with elevated level of CEA was 3.5 months,and the median time of the 5 patients with normal level of CEA was 5.4 months.All the 10 patients who were followed up died of tumor recurrence and metastasis.Conclusion The clinical presentation of patients with acute and chronic pancreatitis as the initial symptoms is atypical,and it is difficult to achieve early diagnosis.Dynamic monitoring and combined diagnosis with laboratory and imaging examinations will improve the accuracy of diagnosis.Surgery based treatment is the preferred option.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第11期859-863,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81373875）
辽宁省医学高峰建设工程项目（ZX201004）
关键词
胰腺肿瘤
胰腺炎
诊断
治疗
Pancreatic neoplasms
Pancreatitis
Diagnosis
Treatment
