自身免疫性胰腺炎23例临床分析

Clinical Analysis of Autoimmune Pancreatitis:A Report of 23 Cases

目的总结自身免疫性胰腺炎（AIP）的临床诊治经验。方法回顾性分析1995~2005年我院诊治的AIP患者的临床表现、影像及病理学特征和诊疗方法。结果符合美国Mayo Clinic医院诊断标准的AIP患者共23例,临床表现主要为：间歇性或进行性黄疸16例（70%）,轻度腹痛或上腹不适9例（39%）,体重减轻10例（43%）,3例无症状。影像学特点包括：胰腺肿大,尤以胰头明显（16例）,主胰管狭窄（9/15）及胰腺段胆总管狭窄合并近端胆管扩张。病理可见胰腺组织内广泛的淋巴细胞和浆细胞浸润和实质纤维化。诊断主要依赖临床表现、影像学和病理学特征。临床误诊为胰胆恶性肿瘤22例,入院误诊率为96%。21例实施手术,2例口服泼尼松治疗。平均随访45个月未发生胰腺癌。结论自身免疫性胰腺炎是一种特殊类型的慢性胰腺炎,因临床特点和胰腺癌极其相似而常采取手术治疗;鉴别诊断时若未能意识到AIP的可能性,常导致AIP的误诊。

Objective To summarize the experience of diagnosis and management of autoimmune pancreatitis （AIP）. Methods Retrospective analysis was done on clinicopathologic characteristics , images, methods of treatment in patients with AIP who were treated in our hospital from 1995 to 2005. Results Twenty - three patients were diagnosed as AIP according to the Mayo Clinic Diagnostic Criteria. The main clinical manifestations were Intermittent or progressive jaundice in 16 cases （70%）, mild epigastric pain or discomfort in 9 cases （39%）, weight loss in 10 cases （43%）, and no symptoms in 3 cases. The imaging characteristics were pancreatic enlargement, especially in pancreatic head （ 16 cases）, strictures of main pancreatic duct and intrapancreatic common bile duct with dilation of proximal bile duct. Massive lymphocytes and plasma cells infiltration and parenchymal fibrosis were showed in pancreatic tissues in pathology. The diagnosis of AIP relied on clinical manifestation , image, and pathologic findings. Twenty - two cases were misdiagnosed as pancreatobiliary malignancies with a rate of 96% at admission. Twenty - one patients were operated on, and the other 2 were given a treatment of oral prednisone. No pancreatic cancer was found during a mean 45 - month follow - up period. Conclusion AS characteristics of AIP, which is a typical chronic pancreatitis, are so similar to pancreatic cancer that it can often result in our performing operations. Diagnosis without noticing possibility of AIP will probably lead to misdiagnosis.