自身免疫性胰腺炎误诊为胰腺癌三例临床分析

Clinical Analysis of 3 Autoimmune Pancreatitis Patients Misdiagnosed as Having Pancreatic Cancer

目的总结自身免疫性胰腺炎(autoimmune pancreatitis,AIP)的临床特点、误诊原因及诊疗方法。方法对2015年9月—2016年4月我院收治的3例AIP临床资料进行回顾性分析。结果 3例均为男性,1例表现为无痛性黄疸,1例为消瘦、腹泻,1例为背部胀痛、厌食。3例影像学检查可见胰腺整体或局部增大、肝内外胆管扩张,提示胰腺或胆管占位性病变,外院均误诊为胰腺癌。入我院肝胆胰脾外科后查血清肿瘤标志物正常,IgG4均升高,诊断为AIP。1例经胰胆管逆行造影胆总管支架置入术,辅以糖皮质激素治疗,术后3个月病情稳定后取出支架;2例仅予糖皮质激素治疗。3例病情均稳定。结论对于合并胰腺弥漫性增大的疑似胰腺癌患者,需考虑AIP可能,行血清免疫学检测及试验性糖皮质激素治疗有助于鉴别,以避免误诊及不必要的手术治疗。

Objective To summarize clinical features, misdiagnosed causes and treatment methods of autoimmune panereatitis （ AIP）. Methods Clinical data of 3 AIP patients during September 2015 and April 2016 was retrospectively analyzed. Results The 3 patients were all males, one patient had painless progressive jaundice, and the second patient had ma- ransis and diarrhoea, and the third patient had back pain and apocleisis. Pancreatic enlargement existed totally or partially, and cholangiectasis was found in exterior and interior of liver, which prompted pancreatic or bile duct occupying lesions by ico- nography examination for the 3 patients. The patients were all misdiagnosed as having pancreatic cancer in other hospitals. Their serum levels of tumor makers were normal, and immunoglobulin G4 （IgG4） levels were elevated after admission in our hospital, and AIP was confirmed. One patient underwent endoscopic retrograde cholangiopanereatography of common bile duct stent implantation, and glucocortieoids treatment was given, and then stent was taken off in postoperative 3 months when he was in a stable condition. The other 2 patients received glucocorticoids treatment. The 3 patients were in stable conditions. Conclusion AIP should be suspected for doubt pancreatic cancer patients with pancreatic diffuse enlargement. Serum immunological test and experimental glucoeorticoid therapy should be performed to help differential diagnosis in order to avoid misdiagnosis and unnecessary operations.