胰头部肿块鉴别诊断和临床对策

Differential diagnosis and surgical strategies for pancreatic head mass

胰头部肿块的鉴别诊断中最为困难的是胰头肿块型胰腺炎与胰腺癌的鉴别。近年来,血清肿瘤标记物检查、多排螺旋CT和内镜超声引导穿刺活检等技术的发展为临床鉴别诊断提供了很多帮助,但仍有部分病人不能通过非手术方法获得确诊。对于这些病人,在与病人及家属进行充分沟通后,可以考虑行剖腹探查,建议术中对胰头部肿块行细针多点穿刺细胞学检查,并由专业人员及时处理标本。慢性胰腺炎是胰腺癌的癌前病变,并且可以导致胰管、胆管及十二指肠梗阻,行胰十二指肠切除术或保留十二指肠的胰头切除术能切除病变,缓解疼痛症状,改善病人的生活质量。但由于该手术创伤大,术后并发症发生率较高,应严格掌握手术适应证,加强围手术期处理,由经验丰富的医师实施手术,将并发症的发生率降到最低。

The indications of surgical intervention for pancreatic head mass have not reached consensus among the surgeons. The most difficult is the differential diagnosis of inflammatory mass and carcinoma in pancreatic head. In recent years, the development of serum tumor marker examination, multi-slice spiral CT and endoscopic ultrasound-guided biopsy techniques provide more practical means for clinical decisions, but there are still some diagnosis can not be confirmed with non-surgical method. For these cases, exploratory laparotomy can be considered after full communication with patients and their families. And fine needle aspiration cytology for the pancreatic head mass is proposed during the procedure accompanying by pathologists for the timely processing of specimens. Chronic pancreatitis with an inflammatory mass of pancreatic head is a precancerous lesion of pancreatic cancer, and can lead to obstruction of pancreatic duct, bile duct and duodenum. The pancreaticoduodenectomy or duodenal reserved resection of pancreatic head can be performed to relieve the pain symptoms and improve quality of life of patients. However, due to the surgical trauma, and a relatively high incidence of postoperative complications, surgical indications should be strictly limited to selected cases and operations should be performed by experienced surgeon.