以急性胰腺炎为始发症状的胰腺占位病变的诊治:附12例分析  

Diagnosis and treatment of pancreatic occupying lesions with initial presentation of acute pancreatitis: an analysis of 12 cases

作　　者：张春晨[1] 靳君华[1] 任建军[1] 张俊晶[1] 乌新林[1] 孟兴凯[1] 杨成旺[1] 

机构地区：[1]内蒙古医科大学附属医院普通外科,内蒙古呼和浩特010050

出　　处：《中国普通外科杂志》2016年第3期345-349,共5页China Journal of General Surgery

基　　金：内蒙古医科大学附属医院重大科研资助项目(NYFYYB2014015)

摘　　要：目的:总结始发症状为急性胰腺炎(AP)的胰腺占位性病变的临床特点,以期为今后该类情况的诊治提供借鉴。方法:收集内蒙古医科大学附属医院于2010年9月—2014年10月收治的12例典型上述病例资料,对其临床表现、实验室指标、影像学特点等多项参数进行综合分析。结果:12例患者均诊断为AP入院;男女性别比列为11:1,明显高于胰腺癌发病的性别比(1.4:1);12例(100%)尿淀粉酶均显著增高(>1500IU/L),伴明显腰部放射痛8例(66.7%),CA19-9升高6例(50.0%);胆红素增高6例(50.0%),胰管扩张7例(58.3%);5例获根治性手术,其余因失去根治手术机会行非手术或姑息手术治疗,其中1例(8.3%)姑息手术术后病理确诊慢性胰腺炎。结论:在AP患者中,男性患者、尿淀粉酶持续增高、伴有腰部放射痛、轻度胰管扩张、黄疸持续不退等对胰腺占位病变的诊断有提示作用。Objective： To review the clinical characteristics of pancreatic occupying lesions with initial presentation of acute pancreatitis（AP）, for providing warnings of this condition. Methods： The data of 12 typical cases with above condition admitted between September 2010 and October 2014 were collected, and variables such as clinical findings, laboratory parameters and imaging features were comprehensively analyzed.Results： All of the 12 patients were admitted for AP; the male to female ratio was 11：1, which was remarkably higher than that（1.4：1） of pancreatic cancer. The urine amylase was markedly increased（〉1 500 U/L） in all cases（100%）, 8 cases（66.7%） were accompanied with evident radiating pain around the waist, 6 cases（50.0%） showed increased CA19-9 level, 6 cases（50.0%） had elevated serum bilirubin level and pancreatic duct dilation wasfound in 7 cases（58.3%）. Five cases underwent radical surgery, and the other cases had non-surgical treatment or palliative operation due to loss of chance for radical surgery, and one of the cases（8.3%） undergoing palliative operation was pathologically proven to be chronic pancreatitis after operation.Conclusion： Among the AP patients, pancreatic occupying lesions should be taken into consideration in those with factors that include male sex, increased urine amylase, pancreatic duct dilation, and accompanied with pain radiating around the waist and persistent jaundice.

关 键 词：胰腺炎/诊断 胰腺肿瘤 诊断 鉴别 

分 类 号：R657.5[医药卫生—外科学]