以腹泻黄疸与胆管扩张为首发症状的早期胰腺癌临床分析  

To analyze the relationship of diarrhea jaundice,extended bile duct with pancreatic neoplasm

作　　者：张丽娟[1] 邢宝春[1] 张国庆[1] 

机构地区：[1]河南省卫辉市新乡医学院第一附属医院介入科,453100

出　　处：《中国实用医药》2008年第3期33-35,共3页China Practical Medicine

摘　　要：目的探讨早期胰腺癌的临床表现与诊断方法,提高胰腺癌的早期诊断率。方法对资料完备的64例胰腺癌患者的临床资料进行回顾性分析。结果首发症状腹泻者24例,初次B超检查均发现肝内外胆管轻度或中度扩张,其中3例合并胰管扩张;首发症状黄疸者22例,初次B超检查发现胰头部呈局限性肿大,主胰管重度扩张,肝内外胆管及胆总管中度或重度扩张。首发症状腰背疼痛18例,初次B超检查发现胰体尾边缘部有高回声光团,主胰管、胆总管不扩张。B超、CT、磁共振胰胆管造影(MRCP)及内镜逆行胰胆管造影(ERCP)为重要的辅助检查。手术、B超或CT引导下穿刺活检是最直接诊断的依据。血清癌胚抗原(CEA)和糖类抗原19-9(CA19-9)联合检测是确诊的最佳手段。结论重视胰腺癌的早期非特异性症状,警惕肝内外胆管轻度或中度扩张可能为早期胰腺癌,对高危可疑患者应联合应用影像学、肿瘤标志物、穿刺、剖腹探查等方法提高诊断率。Objective To summarize the clinical experience and early diagnosis of the pancreatic neoplasm（PN）and to increase the early diagnosis rate of PN. Methods 64 cases with pancreatic neoplasm are studied retrospectively. Results 24 cases have the earliest symptom of diarrhea, examination of B-uhrasound discovers the hepatic ducts are extended slightly or moderately,in which there are 3 cases with extended pancreatic ducts. There are 22 cases with jaundice of the earliest symptom. B-uhrasound finds that the head of pancreas is swelling, the majority pancreatic duct is gravity extended and the hepatic ducts and the common bile ducts are extended moderatly or gravitily. There are 18 cases,the earliest symptom of lumbago. B-uhrasound discovers hyper echo area on the boundary of the body and the tail of pancreas, but the common pancreatic ducts and common bile ducts entextended. Image examination are essential which include B-ultrasound, CT, MRCP, ERCP. Surgery,B-uhrasound and Puncture in the direct of CT is the directest diagnosis evidence of PN definition. Testing both CEA and CA19-9 can ensure the diagnosis. Conclusion Be careful with the early non-particular symptoms of PN and the impossibility that the extended slightly or moderatly hepatic ducts are critical for the early tumor of PN. For the high-risk,image examination, puncture and disemboweling examination are useful for increased the diagnosis rate of PN.

关 键 词：胰腺癌 腹泻 胆管 早期诊断 

分 类 号：R735.9[医药卫生—肿瘤] R657.4[医药卫生—临床医学]