壶腹周围癌35例误诊临床分析

Misdiagnosis of Periampullary Carcinoma: an Analysis of 35 Cases

目的分析壶腹周围癌的临床特点,以减少误诊。方法对我院收治并误诊的35例壶腹周围癌的临床资料进行回顾性分析。结果本组误诊为消化性溃疡8例,胆道感染、胆结石7例,药物性肝损伤、功能性消化不良各5例,慢性胃炎4例,病毒性肝炎、酒精性肝炎、急性胰腺炎各2例。经B超、CT、胰胆管成像(MRCP)明确诊断19例,手术确诊9例,经逆行胰胆管造影(ERCP)诊断6例,经超声内镜(EUS)下的细针穿刺活检诊断1例。结论 B超、螺旋CT、MRCP检查和肿瘤相关指标检测可提高壶腹周围癌的诊断率,必要时行ERCP及刷片、EUS下的细针穿刺活检或剖腹探查,早期诊断可改善壶腹周围癌的预后。

Objective To analyze the clinical feature of periampullary carcinoma in order to reduce misdiagnosis rate and promote diagnosis level. Methods The clinical data of 35 periampullary carcinoma in our hospital were retrospectively analyzed. Results Among the 35 patients, 8 patients were misdiagnosed as having peptic ulcer, 7 as having infection of biliary tract and gallstone, 5 as having drug hepatic injury; 5 as having functional dyspepsia, 4 as having chronic gastritis, 2 as having virus hepatitis, 2 as having alcohol hepatitis and 2 as having acute pancreatitis. 19 patients were diagnosed definitely by type-B ultrasonic, CT and MRCP, 9 by operation, 6 by ERCP and 1 by biopsy. Conclusion Type-B ultrasonic, CT, MRCP and correlated index of tumor can improve the diagnosis rate of periampullary carcinoma. It can be diagnosed by ERCP, fine needle aspiration under the ultrasonic endoscope and exploratory laparotomy. Early diagnosis can improve the prognosis of peri-ampullary carcinoma.