自身免疫性胰腺炎:外科医生的挑战与困惑

Autoimmune pancreatitis: the puzzle that challenges pancreatic surgeon

自身免疫性胰腺炎的诊断和治疗仍有许多难点。诊断宜采用国际标准;影像学诊断不明时ERCP可以提供有价值的诊断信息,激素诊断性治疗需谨慎,需穿刺排除恶性肿瘤方可采用。病灶获得手术切除的病人也需激素治疗,小剂量长期激素治疗有助于降低复发率。胰腺肿块经各项检查(包括穿刺活检)诊断无法明确时,建议开腹活检或手术切除病灶。

There still remains lots of difficulties in the diagnosis and treatment of autoimmune panereatitis. The International Consensus Diagnostic Criteria forAutoimmune Pancreatitis is suggested to be applied in diagnostic workup. ERCP is valuable when radiological evidence is vague. The interpretation of response to steroid should be cautious; the possibility of malignant tumor needs to be excluded. Steroid is necessary even for patients after operation. Long term steroid maintain could decrease the recurrence rate. Open laparotomy or pancreatectomy is necessary for patients whose diagnosis is debatable after all kinds of diagnostic workups.