胰管结石合并胰腺癌的诊治分析(附9例报道)

Diagnosis and Surgical Treatment for Pancreatic Ductal Stones Combined with Pancreatic Cancer: A Report of 9 Cases

目的总结胰管结石合并胰腺癌的诊治经验。方法回顾性分析2005年1月至2015年12月期间中山大学孙逸仙纪念医院收治的9例胰管结石合并胰腺癌患者的临床资料,总结其临床特征、影像学诊断方法和手术方式。结果 9例胰管结石合并胰腺癌患者中,4例行B超联合CT血管造影（CTA）,均诊断为胰管结石合并胰腺癌;4例行磁共振胰胆管造影/磁共振血管显像（MRCP/MRA）,3例考虑胰管结石合并胰腺癌;3例行经内镜逆行性胰胆管造影（ERCP）,均诊断为胰腺癌。所有患者均行手术治疗,包括胰十二指肠切除术4例,胰体尾及脾切除术3例,胰管切开取石、远端胰管空肠吻合术1例,腹腔镜探查、活检术1例。术后无死亡病例,发生应激性溃疡出血1例,B级胰瘘1例。所有患者均获访,随访时间5～36个月,中位数为13个月。随访期间死亡7例,5例生存时间超过1年,2例生存时间超过3年。结论对于反复发作的胰管结石患者应该警惕合并胰腺癌的可能,CT和MRCP均可作为该病的进一步检查方法;影像学检查发现胰腺肿物、无手术禁忌证时,均应积极行手术治疗,推荐行标准的胰十二指肠切除或胰体尾切除术。

Objective To summarize the diagnosis and surgical treatment experience of pancreatic ductal stones combined with pancreatic cancer. Methods Nine cases of pancreatic ductal stones combined with pancreatic cancer who treated in our hospital from January 2005 to December 2015 were collected to make a retrospective analysis, summarizing the clinical features, imaging diagnosis, and surgical treatment. Results Four of 9 cases received ultrasound combined with CT angiography, and all of them were diagnosed as pancreatic ductal stones combined with pancreatic cancer; 4 cases received magnetic resonance cholangiopancreatography（MRCP）/magnetic resonance angiography（MRA）, and 3 cases were considered as pancreatic ductal stones combined with pancreatic cancer; 3 cases received endoscopic retrograde cholangiopancreatography（ERCP）, and all of them were diagnosed as pancreatic cancer. All of the 9 cases underwent surgery, including 4 cases of pancreaticoduodenectomy, 3 cases of distal pancreatectomy with splenectomy, 1 case of pancreatolithotomy plus distal pancreaticojejunostomy, and 1 case of laparoscopic exploration with biopsy. No one died after surgery, but gastric stress ulcer bleeding happened in 1 case, and class B pancreatic fistula happened in 1 case. All of the 9 cases were followed-up for 5-36 months, with the median were 13 months. Seven cases died during follow up period, 5 cases survived longer than 1 year, and 2 cases survived longer than 3 years. Conclusions For patients with recurrent pancreatic stones, we should be wary of the possibility of combining pancreatic cancer, CT and MRCP can be used as further examination of this disease, a variety of imaging methods combination can improve the diagnosis. If imaging examination reveals swollen pancreas without surgical contraindications, surgery is necessary, and standard pancreaticoduodenectomy or pancreas body and tail resection is recommended.