摘要
目的探讨肿块型慢性胰腺炎影像学及临床特征。方法总结经术后病理证实的肿块型慢性胰腺炎20例患者的临床、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男性患者,主要临床表现为腹部不适及梗阻性黄疸。血清肿瘤糖类抗原19-9可有轻度升高,通常在100kU/L左右,较胰腺癌水平低。B超诊断肿块型慢性胰腺炎的准确率仅20%;CT诊断的准确率为45%,表现为主胰管及其分支的扩张影,可见胰腺假性囊肿形成和钙化;磁共振胰胆管造影和超声内镜均可见胆总管及胰管的不规则扩张影,与胰腺癌表现相似;内镜逆行胰胆管造影术可清楚显示胰胆管的病变部位、胰胆管的狭窄及扩张情况等。术后病理均可见胰腺内腺泡减少或消失,纤维组织显著增生同时伴慢性炎性细胞的浸润,1例诊断为自身免疫性胰腺炎。19例患者术后随访恢复均较好。结论肿块型慢性胰腺炎的临床及影像学特征与胰腺癌有相似之处,临床上需结合病史、临床表现、实验室检查、影像学检查及组织病理结果进行综合判断。
Objective To investigate the clinical and imaging features of mass forming chronic pancreatitis （CP）. Methods The clinical, radiologic, laboratory and pathologic profiles of twenty 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 carbohydrate antigen（CA） 19 -9 was slightly elevated, generally below 100 kU/L,which was lower than that of pancreatic carcinoma. The diagnostic accuracy of B - ultrasound for mass forming CP was only 20% and it could only be the screening method;the diagnostic accuracy of CT was 45%, and the main CT features included dilation of main pancreatic duct and the branches, as well as pancreatic pseudocysts or calcification. The findings of magnetic resonanced eholaugio - pancreatography （MRCP） and endoscopic ultrasonography（EUS） were irregular dilation of main pancreatic duct and common bile duct, which were similar to pancreatic carcinoma. Endoscopic retrograde cholangiopancreatography （ERCP） could provide imaging characteristics of biliary and pancreatic duct, and the nature of obstruction, the stricture and dilation of biliary and pancreatic duct. Pathological findings showed decreased pancreatic acini or even disappear, markedly proliferation of fibrous tissue and infiltration of chronic inflammation cells, one case was diagnosed with autoimmune pancreatitis. Postoperative follow -up showed 19 patients recovered well.Conclusion The clinical and radiologic features of mass forming CP are similar to those of pancreatic carcinoma. It is necessary to make a diagnosis by carefully evaluating clinical and imaging findings, laboratory findings and histopathological examinations.
出处
《河北医科大学学报》
CAS
2011年第12期1380-1383,共4页
Journal of Hebei Medical University
关键词
胰腺炎
慢性
摄影术
病理学
pancreatitis, chronic
photography
pathology
