70例胰腺癌的临床诊断过程总结分析

Analysis of The Processes of The Diagnosis of 70 Cases With Pancreatic Cancer

目的 了解胰腺癌临床诊断特点 ,提高胰腺癌早期诊断率。方法 回顾性研究 1990年～ 2 0 0 0年胰腺癌住院患者 70例 (男 4 8例 ,女 2 2例 ,年龄 :36～ 83岁 ,平均年龄 6 3 7岁 )。结果 临床分期 :Ⅰ～Ⅱ期 8例占11 4 %。有症状后仅 4 0例 (5 7 1% )患者在一月内就诊 ,其中 19例 (2 7 1% )在有症状后一月内得到确诊 ,Ⅰ～Ⅱ期为 5例 (2 6 3% )。胰腺癌的首发症状多为腹痛 5 2例 (74 3% )、黄疸 7例 (10 1% )、上腹不适 4例 (5 8% )等。 4 0例 (5 7 1% )患者曾误诊为其它疾病 ,多为慢性胃炎 15例、慢性胆囊炎 5例、溃疡病 4例等。CA199升高 16 / 18例(88 9% ) ,CA12 5升高 6 / 7例 (85 7% ) ,其中 3例Ⅰ～Ⅱ期患者仅CA12 5升高。 5例在确诊前 5个月内因血糖升高诊断糖尿病。结论 胰腺癌确诊时中晚期占大多数 ,就诊晚、误诊、胰腺癌发展快为其主要原因。首发症状多为腹痛、黄疸、上腹不适等 ,慢性胃炎、胆囊炎、溃疡病为误诊的主要疾病。CA199、CA12 5升高对胰腺癌敏感性较高 ,应重视CA12 5、血糖升高的早期诊断价值。

Objective To study clinical feature of diagnosis of pancreatic cancer,in order to reach early diagnosis.Methods 70 cases of pancreatic cancer from ours in-patients 1990 to 2000 were reviewed and analyzed.Results The number of patients with stage Ⅰ～Ⅱ were only 8 cases(11 4%). 40 patients (57 1%) hospitalized within one month after they felt ill.19 cases(29 1%) were diagnosed as pancreatic cancer within one month,including 5 patients(26 3%) with stage Ⅰ or Ⅱ .Abdominal pain(73 4%),jaundice(10 1%) and discomfort of upper abdominal(5 8%) were the most common initial symptoms.misdiagnosis were 40(57 1%) cases .The most common misdiagnosis were chronic gastritis(21 4%),chromic cholecystitis(7 14%) and peptic ulcer(5 71%).The serum levels of CA199,CA125 were higher in 16/18 cases (88 9%) and 6/7 cases (85 7%) respectively. Three cases in stage I or II were found higher serum CA125 and other tumor marker normal.Five patients were diagnosed as diabetes within five months before the diagnosis of the cancer.Conclusions For most of the patients with pancreatic cancer ,usually they were definite diagnosis in moderate or advanced stage. So the status of the diagnosis of pancreatic cancer is disappointed . Hospitalizing late,being misdignosed and developing quickly were the main causes;The most common misdiagnosis are chronic gastritis, cholecystitis and peptic ulcer;elevation of serum CA199 and CA125 are sensitive to diagnose pancreatic cancer. Detections of CA125 and hyperglycemia may favour earlier diagnosis of pancreatic cancer.