对IgG4相关性硬化性胆管炎误诊为胆管癌的治疗体会  

Experience in the treatment of IgG4- related sclerosing cholangitis misdiagnosed as cholangiocarcinoma

作　　者：袁玉斌 孙智勇[1] YUAN Yu-bin;SUN Zhi-yong(Heze Municipal Hospital,Hepatobiliary surgery,Heze 274000,China)

机构地区：[1]菏泽市立医院肝胆外科,菏泽274000

出　　处：《肝胆外科杂志》2020年第4期264-266,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨IgG4相关性硬化性胆管炎的临床特点及诊疗方法,分析总结经验,减少误诊。方法回顾性分析我院肝胆外科误诊为胆管癌的1例IgG4相关性硬化性胆管炎患者的临床资料,复习相关文献,总结归纳,提高IgG4相关性硬化性胆管炎的诊断率。结果经手术探查,结合术中冰冻切片检查提示不除外IgG4相关硬化性疾病,行胆管空场Roux-en-Y吻合,术后结合病理及血清IgG4定量检查后诊断为IgG4相关性硬化性胆管炎,给予泼尼松治疗,病情明显好转后顺利出院。结论IgG4相关性硬化性胆管炎虽然有时与胆管癌不易鉴别,但及时行IgG4定量检测、结合完善的影像学检查,必要时行MDT讨论及病理检查可以避免或减少误诊。Objective To explore the clinical characteristics,diagnosis and treatment of IgG4-related sclerosing cholangitis,analyze and summarize experience and reduce misdiagnosis.Methods The clinical data of a patient with IgG4-related sclerosing cholangitis misdiagnosed as cholangiocarcinoma in hepatobiliary surgery of our hospital were analyzed retrospectively,and the related literatures were reviewed to improve the diagnosis rate of IgG4-related sclerosing cholangitis.Results After surgical exploration,combined with intraoperative frozen section examination,except for IgG4-related sclerosing diseases,bile duct open-field Roux-en-Y anastomosis was performed.After operation,combined with pathology and serum IgG4 quantitative examination,IgG4-related sclerosing cholangitis was diagnosed and treated with prednisone.Conclusion Although IgG4-related sclerosing cholangitis is sometimes difficult to distinguish from cholangiocarcinoma,timely IgG4 quantitative detection,combined with perfect imaging examination,MDT discussion and pathological examination can avoid or reduce misdiagnosis.

关 键 词：IGG4相关性疾病 胆管炎 胆管肿瘤 

分 类 号：R735.8[医药卫生—肿瘤]