非典型影像改变的慢性胰腺炎误诊误治临床探讨  

Clinical Exploration of Misdiagnosis and Mistreatment of Chronic Pancreatitis with Atypical Imaging Changes

作　　者：徐婷 杨琦 张超[1] 杜娟[1] 王芳[1] XU Ting;YANG Qi;ZHANG Chao;DU Juan;WANG Fang(Department of Gastroenterology,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Xi'an 710083,China)

机构地区：[1]西北大学附属医院西安市第三医院消化内科,西安710083

出　　处：《临床误诊误治》2024年第18期21-31,共11页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析慢性胰腺炎(CP)临床表现、影像学、病理学特点,以减少临床误诊误治。方法对2018年5月至2023年5月收治的误诊的CP 4例的临床资料进行回顾性分析。结果4例患者中3例表现为反复腹痛,1例表现为持续腹痛、腹泻,但均无典型的影像学表现,分别误诊为复发性急性胰腺炎(RAP)伴胰腺占位、胰腺癌、RAP及溃疡性结肠炎。误诊时间6个月~3年。1例误诊为RAP伴胰腺占位的患者行超声内镜检查确诊为CP,确诊后予内镜下逆行胰胆管造影术(ERCP)、胰管支架置入术;1例误诊为胰腺癌的患者行胰头及十二指肠切除术、肠粘连松解术后病理检查确诊为CP,1例误诊为溃疡性结肠炎的患者行ERCP联合上腹磁共振成像、超声内镜检查确诊为CP,确诊后给予药物治疗。上述3例患者治疗后症状缓解,未再复发。1例误诊为RAP的患者经查IgG4和超声内镜引导下细针穿刺活检确诊为1型自身免疫性胰腺炎,确诊后经糖皮质激素治疗后未再腹痛,复查肝功能、IgG4及影像学表现好转,但反复出现胃底静脉曲张破裂出血,并数次行内镜下止血治疗及药物保守治疗。结论CP临床表现多样,影像学表现可能不典型,病理取材困难,早期诊断难度大,反复腹痛或胰腺炎发作,或胰腺外分泌功能不全者,应尽早完善相关检查,以减少误诊、漏诊。Objective To analyze the clinical manifestations,imaging and pathological features of chronic pancreatitis(CP)in order to reduce clinical misdiagnosis and mistreatment.Methods The clinical data of 4 patients with misdiagnosed CP admitted from May 2018 to May 2023 were retrospectively analyzed.Results Three of the four patients presented with recurrent abdominal pain,and one patient presented with persistent abdominal pain and diarrhea.However,none of them had typical imaging manifestations,and they were misdiagnosed as recurrent acute pancreatitis(RAP)with a space-occupying lesion of the pancreas,pancreatic cancer,RAP,and ulcerative colitis(UC),respectively.Misdiagnosis lasted from 6 months to 3 years.CP was diagnosed by endoscopic ultrasonography in 1 patient misdiagnosed with RAP and a space-occupying lesion of the pancreas.After diagnosis,endoscopic retrograde cholangiopancreatography(ERCP)and pancreatic duct stent implantation were performed.One patient misdiagnosed with pancreatic cancer was diagnosed with CP by pathological examination after pancreatic head and duodenectomy and intestinal adhesion-lysis.One patient misdiagnosed with UC was diagnosed with CP by ERCP combined with upper abdominal magnetic resonance imaging and endoscopic ultrasound,and was given drug therapy after diagnosis.The symptoms of the above three patients were relieved after treatment and did not recur.A patient misdiagnosed with RAP was diagnosed as type 1 autoimmune pancreatitis(AIP)by IgG4 and endoscopy-guided fine needle biopsy.After diagnosis,there was no abdominal pain following treatment with corticosteroids.Liver function,IgG4 and imaging manifestations improved after review,but the gastric variceal rupture and bleeding repeatedly occurred,and endoscopic hemostasis and conservative drug treatment were performed several times.Conclusion The clinical manifestations of CP are varied,the imaging manifestations may be atypical,the pathological sampling is difficult to obtain,and the early diagnosis is difficult.For patients with r

关 键 词：胰腺炎 慢性 误诊 复发性急性胰腺炎 胰腺肿瘤 结肠炎 溃疡性 自身免疫性胰腺炎 免疫球蛋白G 超声内镜 

分 类 号：R576[医药卫生—消化系统]