摘要
目的探讨我国Ig G4相关硬化性胆管炎(Ig G4-RSC)的临床特点、治疗策略以及预后。方法收集国内资料完整的符合Ig G4-RSC诊断标准的36例病人结合我院诊治的一例进行研究分析,探讨该病的临床特点、诊断、治疗以及预后。结果男28例,女9例。好发年龄于50-60岁之间。常见的临床表现主要为梗阻性黄疸(89%)、上腹部不适或疼痛(49%)和消瘦(27%)。15例接受血清学Ig G4检查有14例(93%)升高。22例Ig G检查中21例(95%)升高,29例CA19-9检查中18例(62%)升高。影像学检查:37例中33例胆总管下段狭窄(89%),4例肝门区胆管和胆总管中下段狭窄(11%)。37例均合并自身免疫性胰腺炎(AIP),多发淋巴结肿大3例(7%)。14例接受外科手术,术后病理证实Ig G4-RSC,5例术后加用激素治疗。23例行激素治疗,其中6例施行胆管支架植入,症状均有缓解。6例复发,再次行激素治疗后症状缓解。结论 Ig G4-RSC好发于中老年男性,常以梗阻性黄疸就诊,血清学检查Ig G4多有升高,常合并有自身免疫性胰腺炎,病理学检查有助于诊断(术前较难获得),激素治疗有效,复发再次激素治疗,症状仍能缓解。
Objective To explore the clinical characteristic and treatment strategy of Chinese IgG4-related sclerosing cholangi- tis. Methods 37 cases of IgGg-RSC reported in China were reviewed retrospectively with their clinical characteristic, diagnosis, treatment, and outcome. Results the main clinical manifestations are obstructive jaundice（89% ,33/37 ） ,upper abdominal discomfort or pain in 18 （49%） patients, emaciation in 10 （27 % ） patients. Immnnoglobulin （IgG） has been detected among 22 cases,21 （95 % ） cases increased, IgG4 is checked in 14 cases, 13 （92%） cases increased. CA19-9 have been examined in 29 cases, 18 （62%） cases are positive. Imaging examination findings implied that stenosis is located only in the lower part of the common bile duct in 33 （89%） cases, Stenosis is detected in both the hilar hepatic lesions and the lower part of the common bile ducts in 4 （ 11% ） cases, no case is found in stenosis diffusely distributed in the intra- and extrahepatic bile ducts or strictures of the bile duct only in the hilar hepatic. 37 （100%） cases are complicated with autoimmune pancreatitis. 14 cases accepted surgical treatment, Postoperative pathology confirmed IgGg-RSC, 23 cases accepted hormone therapy, the clinical symptoms were eased. 6 cases were relapse, but they were remission after using hormone again. Conclusions IgG4-RSC often occurs in middle-aged men around 58y, most with obstructive jaundice, with IgG4 increasing, with autoimmune pancreatitis, sensitive to hormone therapy,if relapse,hormone therapy was still effective.
出处
《肝胆外科杂志》
2015年第2期117-120,共4页
Journal of Hepatobiliary Surgery
关键词
IGG4
胆管炎
胰腺炎
治疗
诊断
IgG4
Cholangitis
Pancreatitis
Therapy, Diagnosis
