难以鉴别的胰腺肿块的诊治体会与分析  

The analysis and experience in diagnosis and treatment of difficult to identify pancreatic mass

作　　者：谢放[1,2] 黄强[1,2] 刘振[1,2] 林先盛[1,2] 胡俊[1,2] 

机构地区：[1]安徽省立医院普外科胆胰病区,合肥230001 [2]肝胆胰安徽省重点实验室

出　　处：《肝胆外科杂志》2014年第5期352-355,共4页Journal of Hepatobiliary Surgery

基　　金：基金号1301042205;基金名称:安徽省科技攻关项目;基金课题名称:超声内镜联合基因甲基化检测在胰腺占位性病变诊断中的应用

摘　　要：目的探讨自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的临床特点与胰腺癌鉴别的要点,提高对AIP的认识,降低临床误诊率。方法回顾我院普外科近期收治4例自身免疫性胰腺炎的诊疗经过并文献复习,分析总结AIP的诊疗体会。结果 4例患者均以黄疸、腹部不适为主要表现。2例胰腺病变为弥漫型,另2例为局限型;胰管狭窄2例,伴有胆管狭窄2例。4例患者均符合亚洲诊断标准及HISORt诊断标准。3例患者予以口服强的松治疗,随访疗效均良好,另1类患者行手术治疗,术后病理提示符合LPSP,术后恢复良好。结论 AIP是一种与免疫相关的特殊类型的慢性胰腺炎,临床少见,与胰腺癌难以鉴别,可结合血清IgG4水平、影像学表现、超声内镜下细针穿刺及诊断性应用激素等综合判断。Objective To investigate the clinical characteristics of autoimmune pancreatitis and identify the Different points with pancreatic cancer. To improve the understanding of AIP and reduce the clinical misdiagnosis rate. Method Reviewed the literature and retrospective analyses the diagnosis and treatment of 4 cases of autoimmune pancreatitis. Result The main performance of 4patients were jaundice and abdominal discomfort. The pancreatic lesions of 2 cases were diffuse type,the other 2 were localized. 2 cases of patients were simple stricture of pancreatic duct,the other 2 cases moreover occurred with bile duct stricture. 4 patients were according to the diagnostic criteria of HISORt and Asia. 3 patients received the treatment of Oral prednisone,the other one accepted operation treatment and LPSP was confirmed by pathology. All patients Recovered well. Conclusion AIP is a special type of chronic pancreatitis associated with immune which was difficult to identify with pancreatic cancer. We suggest the diagnosis of AIP may be combined with serum IgG4 levels,imaging manifestations,fine needle aspiration on EUS guided and diagnostic treatment with hormone.

关 键 词：自身免疫性胰腺炎 胰腺癌 IGG4 

分 类 号：R658[医药卫生—外科学]