摘要
目的探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的诊治方法、误诊原因及防范措施,提高临床医生对AIP的认识及诊疗水平。方法回顾性分析1例延误诊治4年的AIP的临床资料。结果患者因发现胰腺肿物4年,间断上腹痛2年,再发2 d入院。4年前患者健康体检时行超声检查发现胰腺肿物,住院经CT及超声内镜引导下胰腺穿刺活组织病理检查等考虑胰腺肿瘤,未予治疗。2年前突发右上腹疼痛入院,经Ig G4及影像学等检查,考虑不除外AIP,建议试验性糖皮质激素治疗但患者拒绝。此次入院后经Ig G4、超声及MRI检查考虑AIP,充分与患者沟通后给予甲泼尼龙试验性治疗1个月,复查胰腺增强CT提示胰腺占位缩小,确诊AIP,出院。出院后随访9个月,无复发。结论 AIP是一种特殊类型的慢性胰腺炎,临床少见,易误诊。提高对其认识、发散诊断思维及加强与患者及其家属沟通交流可减少其误诊误治。
Objective To discuss diagnostic measures,treatment measures,causes of misdiagnosis and preventive measures of autoimmune pancreatitis,in order to improve the awareness of autoimmune pancreatitis（ AIP）,and also levels of diagnosis and treatment of the disease. Methods Clinical date of a case of AIP with delayed diagnosis and treatment for four years was retrospectively analyzed. Results The patient was admitted for pancreatic mass for 4 years with 2-year interrupted epigastric pain and an acute onset 2 days before. The pancreatic mass was found 4 years ago by ultrasound during a physical examination,which was suspected as a tumor of pancreas with pathological diagnosis after needle-biopsy guided by CT and endoscopic ultrasonography,but without any treatment. 2 years ago,the patient was admitted for a sudden right epigastric pain.After the patient underwent Ig G4,and imaging examinations,AIP was not excluded,and the patient refused to accept the suggested experimental glucocorticoid therapy. Upon this admission,we still considered it as AIP after examination of Ig G4,ultrasound and MRI examinations,and then took 1-month experimental treatment with prednisone with the agreement from the patient. The pancreatic mass shrank under enhancement CT,and a definite diagnosis of AIP was made. Followed up for 9months after discharge,the patient had no recurrence. Conclusion AIP is a special type of chronic pancreatitis,which is rare clinically and easy to be misdiagnosed. Clinicians should raise awareness of the disease,strengthen diagnostic thinking and communication with the patients＇ families in order to reduce misdiagnosis and mistreatment rates.
出处
《临床误诊误治》
2016年第2期28-32,共5页
Clinical Misdiagnosis & Mistherapy
关键词
胰腺炎
误诊
胰腺肿瘤
Pancreatitis
Misdiagnosis
Pancreatic neoplasm
