肿块型胰腺炎与胰腺癌的超声诊断与鉴别

Diagnosis and differential diagnosis of inflammatory pancreatic masses and pancreatic cancers by ultrasonography

目的探讨肿块型胰腺炎与胰腺癌的超声表现及鉴别诊断要点。方法回顾性分析我院2001年1月至2010年7月临床确诊的38例肿块型胰腺炎患者和35例胰腺癌患者影像学检查资料,总结其超声声像图特点及鉴别要点。结果肿块型胰腺炎与胰腺癌超声诊断符合率分别为73.7%(28/38)和77.1%(27/35)。17例(44.7%,17/38)肿块型胰腺炎患者出现病灶内强回声斑块,胰腺癌患者中均无此征,两者之间的超声声像图显示率差异有统计学意义(P<0.01);肿块型胰腺炎患者出现后方回声增强的比例(50.0%,19/38)明显高于胰腺癌患者(8.6%,3/35,P<0.01);胰腺癌患者中出现腹腔淋巴结肿大的比例(45.7%,16/35)明显高于肿块型胰腺炎患者(5.2%,2/38,P<0.01)。肿块型胰腺炎患者胰管多表现为不光滑扩张并贯穿(26.3%,10/38);胰腺癌患者胰管表现为光滑扩张并中断的比例(54.3%,19/35)明显高于肿块型胰腺炎患者(7.8%,3/38,P<0.05)。肿块型胰腺炎和胰腺癌的超声声像图表现在发病部位、肿块边界轮廓、内部回声、邻近血管的变化及肿块内血流特征等与胰腺癌极为类似,存在较多重叠而难予鉴别,两者之间的超声声像图显示率差异无统计学意义(P>0.05)。结论超声对肿块型胰腺炎与胰腺癌的鉴别诊断具有重要价值。病灶内强回声斑块、病灶后方回声增强、胰管及胆管改变及伴有淋巴结增大是超声检查诊断肿块型胰腺炎和胰腺癌的鉴别要点。

Objective To explore the characteristics of diagnosis and differential diagnosis of inflammatory pancreatic masses （IPM） and pancreatic cancers （PC） by ultrasonography. Methods A total of 38 patients with IPM and 35 patients with PC, who were clinically diagnosed from January 2001 to July 2010, were enrolled in this study and their disease characteristics of ultrasound were analyzed. ResultsThe diagnostic accordance rate of ultrasound was 73.7% in IPM group and 77.1% in PC group, respectively. A high echo in the masses was shown in the 17 patients （44.7%） of IPM group,but none of patients in PC group showed the characteristics. The display rate of ultrasound image between the two groups was greatly different（P0.01）. The rate for back high echo of the masses in IPM group was higher than that in PC group （50% vs 8.6%, P0.01）. However, there were more patients with abdominal lymphadenectasis in PC group （45.7% vs 5.2%, P0.01）. More the pancreas duct dilated with smooth internal wall and interrupted were found in PC group than in IPM group （54.3% vs 7.8%, P0.05）. There were no difference in position, edge, internal echo and blood flow of masses between IPM and PC. The display rate of ultrasound image between the two groups was no difference （P0.05）.Conclusion Ultrasonography is valuable in diagnosis and differential diagnosis of inflammatory pancreatic masses and pancreatic cancers. A high echo in the mass, back high echo of the mass, the change of the commom bile duct and pancreas duct in the mass and the attendant abdominal lymphadenectasis are the main points of the differential diagnosis between IPM and PC.