以急性胰腺炎为首发临床表现的胰腺癌诊治进展  

Progress in the diagnosis and treatment of pancreatic cancer with acute pancreatitis as the initial symptom

作　　者：蒋睿 高崇崇[1] 白剑 李昂[1] 王晓辉[1] 曹锋[1] 李非[1] Jiang Rui;Gao Chongchong;Bai Jian;Li Ang;Wang Xiaohui;Cao Feng;Li Fei(Department of General Surgery,Xuanwu Hospital,Capital Medical University,Clinical Center for Acute Pancreatitis,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院普通外科,首都医科大学急性胰腺炎临床诊疗与研究中心,北京100053

出　　处：《中华外科杂志》2024年第10期971-975,共5页Chinese Journal of Surgery

基　　金：北京市医院管理中心“培育计划”(PX2022035);首都医科大学宣武医院2023年度院级课题(QNPY202321)。

摘　　要：胰腺癌患者常以上腹痛、梗阻性黄疸等主诉入院诊治,但急性胰腺炎作为胰腺癌罕见的首发临床表现,由于其易被临床忽视,常导致胰腺癌的诊断滞后、治疗策略不明,严重影响患者的生活质量及预后。因此,对以急性胰腺炎为首发临床表现的胰腺癌患者做到早期诊断、早期治疗、积极随访是关键。患者以急性胰腺炎为首发临床表现入院时,应首先排除胆结石、酗酒、高脂血症等常见病因,并及时进行肿瘤标志物、CT、MRI、超声内镜等检查以明确胰腺癌诊断。对于伴有轻症胰腺炎的患者来说,先处理炎症渗出后再行胰腺癌手术治疗可减少术后并发症。同时,胰腺炎是发生胰腺癌的高危因素,对胰腺炎患者进行密切随访也是早期发现、早期诊治胰腺癌的重要手段。Pancreatic cancer patients often have complaints such as upper abdominal pain and obstructive jaundice when seeking diagnosis and treatment.However,acute pancreatitis as a rare initial clinical manifestation of pancreatic cancer is often overlooked in clinical practice.This oversight often leads to a delayed diagnosis of pancreatic cancer,uncertainty in treatment strategies,and significantly affects patients′quality of life and prognosis.Therefore,early diagnosis and treatment,and active follow-up are crucial for patients with acute pancreatitis as an initial symptom of pancreatic cancer.Upon admission to such patients,common causes such as gallstones,alcohol abuse,and hyperlipidemia should be initially ruled out.Evaluation with tumor markers,CT and MRI,and endoscopic ultrasound are essential to confirm the diagnosis of pancreatic cancer.For patients with mild pancreatitis,managing peripancreatic inflammation first before radical resection of pancreatic cancer could reduce postoperative complications.Moreover,pancreatitis serves as a high-risk factor for pancreatic cancer,so it is crucial to closely follow up patients with pancreatitis to detect pancreatic cancer early.

关 键 词：胰腺肿瘤 胰腺炎 早期筛查 诊治策略 预后 

分 类 号：R735.9[医药卫生—肿瘤]