摘要
目的探讨胰头、壶腹部癌临床与病理诊断的符合率,提高临床诊断水平。方法回顾性分析1981年1月-2002年12月临床诊断的胰头、壶腹部癌274例。将274例患者分为3组:A组(胰十二指肠切除术)163例,B组(肿瘤未切除者)66例,C组(单纯内镜检查)45例。结果临床诊断胰头、壶腹部痛27d例,与病理诊断比较符合率为73.7%(202/274)。A组临床诊断与病理诊断比较符合率93.2%(152/163),B组为45.4%(30/66),C组为42.2%(19/45)。在122例胰头肿块中,胰头癌符合率为68.85%(84/122),其中A组胰头癌符合率89.71%(61/68),B组43.14%(22/1),C组33.3%(1/3)。在150例壶腹部肿块中,壶腹癌诊断符合率为72.0%(108/150),其中A组为88.17%(82/93),B组为53.3%(8/15),C组为42.85%(18/42)。2例为转移癌。胰头、壶腹部癌临床与病理诊断不符合72例(26.3%),其中15例为慢性胰腺炎,16例为慢性十二指肠黏膜炎,8例为十二指肠黏膜上皮不典型增生和33例其他疾病。B超、CT、内镜、ERCP、血清标志物和PGGT、PGGT/TGGT的联合检测,发现早期胰头壶腹部癌(T1N0M0)30例(13.1%,30/229),其中早期胰头癌9例(10.7%,9/84),早期壶腹部癌21例(14.5%,21/145)。结论早期胰头、壶腹部癌(T1N0M0)诊断困难,应提高其诊断水平;胰头癌和胰头肿块型慢性胰腺炎的鉴别诊断十分重要;在组织病理学确诊胰头、壶腹部癌以前,胰十二指肠切除必须慎重。
Objective To investigate the coincidence of clinical and pathologic diagnoses of carcinoma of pancreatic head and Vater＇s ampulla so as to improve the clinical diagnostic level. Methods In a retrospective study, clinical data of 274 patients with carcinoma ot pancreatic head and Vatier＇s ampulla were analyzed and the patients were divided into 3 groups., group A included 163 patients with pancreaticoduodenectomy, group B included 66 patients with locally unresectable masses, and group C included 45 patients who received endoscopic treatment only. The clinical and pathological diagnoses of carcinoma of pancreatic head and Vater＇s ampulla were analyzed. Results The coincidence of clinical and pathologic diagnoses was 73. 7% （202/274） as a whole, 93. 2%（152/163） in group A, 45. 4% （30/66） in group B, and 42. 2%（19/45） in group C. In 122 patients with pancreatic head mass, the diagnostic coincidence was 68.85%（84/122）, 89.71%（61/68） in group A, 43. 14%（22/51） in group B, and 33.3%（1/3） in group C. In 150 patients with Vater＇sampulla mass, the diagnostic coincidence was 72.0%（108/150）, 88. 17%（82/93） in group A, 53.3%（8/15） in group B and 42. 85% （18/42） in group C. 72 cases which were clinically diagnosed as periampullary tumor were diagnosed as benign pathologically, the non-coincidence being 26.3%（72/274）, including 16 cases of chronic duodenitis, 15 cases of chronic pancreatitis, 8 cases of atypical hyperplasia of duodenal mucous membrane and 33 cases of other diseases. B-uhrasound. CT, endoscopy, ERCP, serum tumor markers and PGGT PGGT/ TGGT were used for diagnosis of tumors of the pancreatic head and Vater＇s ampulla region. Among them, there were 9 patients （10.7%, 9/81 ）with early stage pancreatic head carcinoma and 21 patients （14.5%,21/145） with early stage carcinoma of Vater＇s ampullary region. Conclusions These results show that pathological diagnosis of early stage carcinoma （T1N0M0） of pancreatic head was difficuh and the clinical diagnostic level should be improved. Differential diagnosis between carcinoma mass and inflammation mass in the pancreatic head can be very important and difficult. Choice of panereaticoduodenectomy should be prudent before histopathological diagnosis of carcinoma of pancreatic head and vater＇s ampulla.
出处
《胰腺病学》
2005年第3期132-134,共3页
Chinese JOurnal of Pancreatology
