自身免疫性胰腺炎与胰腺癌在影像学方面的鉴别诊断研究  

The differential diagnosis research between autoimmune pancreatitis and pancreatic cancer on imageological features

作　　者：张新刚[1] 温锋[2] 董幼丹[1] 郭亚军[3] 梁宏元[2] 王晓非[1] 

机构地区：[1]中国医科大学附属盛京医院第一风湿免疫内科,沈阳110004 [2]中国医科大学附属盛京医院放射科,沈阳110004 [3]中国医科大学附属盛京医院超声科,沈阳110004

出　　处：《中国医师进修杂志》2013年第15期4-8,共5页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省医学高峰建设工程（2010027）;沈阳市科学技术计划（2012122333）

摘　　要：目的对比分析自身免疫性胰腺炎（AIP）患者与胰腺癌（PC）患者的影像学资料，提高AIP与PC在影像学方面的鉴别诊断能力。方法选取术后病理符合AIP亚洲标准的患者36例及符合PC病理诊断标准的患者95例，总结AIP与Pc的影像学特点及差异。结果增强CT发现胰头增大或肿块、胰周淋巴结肿大、胰胆管和胆总管扩张及截断、血管和脏器受累方面AIP明显少于PC（11／27比28／40、2／27比17／40、13／27比32／40、1／27比10／40、8／27比26／40、2／27比15140、0／27比15／40、0／27比10／40），差异有统计学意义（P〈0．05），在胰腺普遍增大、钙化或胰石、假包膜影或胰周脂肪间隙模糊方面AIP明显多于PC（4／27比0／40、7／27比0／40、10／27比6／40），差异有统计学意义（P〈0．05）。三维彩超发现在胰胆管扩张直径和胆总管扩张方面AIP明显少于PC[（0．421±0．270）cm比（0．594±0．270）cm、1／18比16／26]，差异有统计学意义（P〈O．05）。磁共振胰胆管成像发现胆总管扩张及胰胆管截断方面AIP明显少于PC（7，13比16／18、1／13比10／18），差异有统计学意义（P〈0．05）。结论AIP作为一种特殊类型的慢性胰腺炎，在影像学方面可与PC进行鉴别诊断。Objective To improve the differential diagnosis between autoimmune pancreatitis （ALP） and pancreatic cancer （PC） by a contrast analysis of imageological features. Methods Thirty-six patients who had postoperative pathological with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC. The imageological results of these AlP and PC patients were analyzed. Results AlP was significantly less than PC in the enhanced CT of a mass or enlargement of the pancreatic head, enlargement of the lymph nodes around the pancreas, dilation and interrupt in pancreatic and bile duct, peripheral vascular and organ involvement （ 11/27 vs. 28/40,2/27 vs. 17/40,13/27 vs. 32/40,1/27 vs. 10/40,8/27 vs. 26/40,2/27 vs. 15/40,0/27 vs. 15/40,0/27 vs. 10/40,P 〈 0.05 ）. AIP was significantly more than PC in the enhanced CT of a diffusely enlarged pancreas, calcification or pancreatic calculus, capsule-like rim or the vague peripancreatic fat interval （4/27 vs. 0/40,7/27 vs. 0/40,10/27 vs. 6/40,P〈 0.05）. AIP was significantly less than PC in the three-dimensional ultrasonography of dilation diameter of pancreatic duct and dilation of common bile duct [ （0.421 ± 0.270） cm vs. （0.594 ± 0.270） cm, 1/18 vs.16/26,P〈 0.05 ]. AIP was significantly less than PC in the magnetic resonance cholangiopancreatography of dilation of common bileduct and interrupt in pancreatic duct （7/13 vs. 16/18,1/13 vs. 10/18,P 〈0.05）. Conclusion AlP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive imageological features

关 键 词：自身免疫疾病 胰腺炎 胰腺肿瘤 

分 类 号：R576[医药卫生—消化系统]