胰头部肿块型慢性胰腺炎20例回顾分析

Chronic pancreatitis with pancreatic head mass: Retrospective analysis of 20 cases

目的探讨胰头部肿块型慢性胰腺炎的诊疗方法。方法回顾性分析20例胰头部肿块型慢性胰腺炎的病例资料,本组患者经超声、CT强化检查及MRCP均提示胰头占位性病变。结果 20例患者均于全麻下行剖腹探查术,术中行细针穿刺多点细胞学检查提示慢性胰腺炎变化,其中11例行胰十二指肠切除术,9例行保留十二指肠的胰头切除术。所有患者术后病理均为慢性胰腺炎,其中CA199最高1例合并导管上皮低级别瘤变。所有患者经定期随访术后恢复良好。结论胰头部肿块型慢性胰腺炎主要症状为黄疸,其诊疗方法首选术中行细针多点穿刺活检;手术探查时肿块与周围粘连重呈浸润性改变患者需行胰十二指肠切除术;肿块与周围粘连不明显无浸润性改变患者可行保留十二指肠的胰头切除术。

Objective To explore the diagnosis and surgical treatment of patients with chronic pancreatitis associated with a pancreatic head mass. Methods Clinical data of 20 patients with chronic pancreatitis associated with a pancreatic head mass were analyzed retrospectively. All of the patients received examinations such as ultrasound, CT strengthened scan and MRCP, which showed the occupying lesions in the pancreatic head. Results All the 20 patients underwent laparotomy under general anesthesia, and received intraoperative fine needle aspiration cytology confirming the diagnosis of chronic pancreatitis. Among them, 11 patients underwent paucreaticoduodenectomy, and 9 patients underwent duodenum-preserving pancreatic head resection. All of postoperative pathological results confirmed the diagnosis of chronic panereatitis, one patient with the highest plasmic level of CA199 was diagnosed as with combined low-level ductal epithelial neoplasia. All the patients uneventfully recoved in a follow-up period. Conclusions The main symptom of chronic pancreatitis with a mass in the pancreatic head is jaundice. The diagnosis and treatment are based on intraoperative fine needle aspiration cytology. Patients with infiltrative changes of severe adhesion around the pancreatic head should receive pancreaticoduodeuectomy, and patients with mild adhesion around the pancreatic head should receive duodenum-preserving pancreatic head resection.