经病理证实的163例胰头占位性病变患者的临床分析  

Clinical analysis of 163 cases of pancreatic head mass lesions confirmed by pathology

作　　者：卓宇果 高青[1] ZHUO Yuguo;GAO Qing(Department of Gastroenterology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院消化内科,重庆400010

出　　处：《胃肠病学和肝病学杂志》2024年第1期73-77,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 分析胰头不同性质占位性病变的临床特征及诊断方法,为临床早期诊断和鉴别提供依据。方法 回顾性分析重庆医科大学附属第一医院2016年1月至2020年12月经病理证实的163例胰头占位性病变患者的资料,分为胰头癌组和非胰头癌组,分析其临床特征,并分析不同检查方法对胰头占位性病变的临床诊断效能和特点。结果 共纳入163例胰头占位性病变患者,其中胰头癌127例,非胰头癌36例。胰头癌组的年龄、总胆红素、直接胆红素、GGT、CA19-9、CA242明显高于非胰头癌组(P<0.05)。血清肿瘤标志物及不同的影像学检查的准确度CA19-9为79.35%、CA242为66.67%、CA19-9+CA242为84.31%;B超检查的准确度为57.14%、增强CT为61.04%、MRI为58.00%、EUS为88.00%、EUS+CA19-9为92.00%。结论 对于胰头占位性病变,尤其是年龄较大、黄疸明显的患者,应高度警惕胰头癌,此时联合检测CA19-9、CA242,并结合EUS及EUS-FNA,可有助于提高对胰头占位病变,特别是早期病变的诊断及鉴别能力,从而进行更精准的术前评估,减少不必要的剖腹探查。Objective To analysis the clinical characteristics and diagnostic methods of space-occupying lesions of the head of pancreas with different natures,and provide a reference basis for early clinical diagnosis and treatment.Methods A retrospective analysis was performed on 163 cases of pathologically confirmed pancreatic head mass lesions in the First Affiliated Hospital of Chongqing Medical University from Jan.2016 to Dec.2020,which were divided into pancreatic head cancer group and non-cancer group.Then the clinical characteristics,the clinical diagnostic efficacy and characteristics of different examination methods for pancreatic head occupying lesions were analyzed.Results A total of 163 pathologically confirmed pancreatic head occupying lesions were included in the study,including 127 cases of pancreatic head cancer and 36 cases of non-pancreatic head cancer.The age,total bilirubin,direct bilirubin,GGT,CA19-9 and CA242 were significantly higher than those in the non-cancer group(P<0.05).The accuracy of serum tumor markers and different imaging examinations were 79.35% for CA19-9,66.67% for CA242,and 84.31% for CA19-9+CA242,ultrasound 57.14%,enhanced CT 61.04%,MRI 58.00%,EUS 88.00%,EUS+CA19-9 92.00%.Conclusion For pancreatic head occupying lesions,especially elderly patients with obvious jaundice,it is necessary to be highly vigilant about the possibility of pancreatic head cancer.At this time,if we test CA19-9 and CA242,then combine with EUS and EUS-FNA,we can help improve the ability of diagnosis and differential diagnosis of pancreatic head occupying lesions,especially early lesions,so as to conduct more accurate preoperative evaluation and reduce unnecessary laparotomy exploration.

关 键 词：胰腺肿瘤 胰头癌 诊断 

分 类 号：R576[医药卫生—消化系统]