外科干预在自身免疫性胰腺炎诊断及治疗中的意义

The role and significance of surgical intervention in the diagnosis and treatment of autoimmune pancreatitis

目的总结自身免疫性胰腺炎(autoimmune pancreatitis,AIP)临床特征,探讨外科干预在AIP治疗中的作用及意义。方法回顾性分析哈尔滨医科大学附属第一医院2011年至2017年接受外科干预的11例术前确诊为AIP和8例术前疑似AIP但不排除胰腺癌患者的临床资料。结果术前确诊的11例AIP患者中,9例(47.4%)行内镜下逆行胰胆管造影并置入鼻胆管或行胆道支架引流,2例(10.5%)行胆总管空肠吻合术。术前不排除胰腺癌的8例(42.1%)患者,4例(21.1%)行胆总管空肠吻合术,3例(15.8%)行胰十二指肠切除术,1例(5.3%)行胰体尾联合脾切除术。根治术后病理证实3例为胰腺癌,1例为IPMN,2例为AIP,2例为慢性胰腺炎。结论自身免疫性胰腺炎是IgG4相关性疾病在胰腺的局部表现,在药物治疗反应不佳且或者无法排除肿瘤可能时,仍需必要的外科干预。

Objective To summarize the clinical characteristics of autoimmune pancreatitis(AIP)and discuss the role and significance of surgical intervention in the treatment of AIP.Methods The clinical data of 11 patients with preoperative confirmed AIP and 8 patients with preoperative suspected AIP receiving surgical intervention at the First Affiliated Hospital of Harbin Medical University from 2011 to 2017 were retrospectively analyzed.Results Among 11 preoperatively confirmed AIP patients,9(47.4%)underwent endoscopic retrograde cholangiopancreatography(ERCP)with nasal bile duct implantation or biliary stent drainage,and 2(10.5%)underwent choledochojejunostomy.Among 8 putative AIP patients in which a cancer was suspected 4(21.1%)underwent choledochojejunostomy,3(15.8%)did pancreaticoduodenectomy,and 1(5.3%)had distal pancreatectomy plus splenectomy.Postoperative pathology confirmed pancreatic cancer in 3 cases,IPMN in 1 case,AIP in 2 cases,and chronic pancreatitis in 2 cases.Conclusion While autoimmune pancreatitis is IgG4 related disease,surgical intervention is indicated when there is poor response to drug treatment or when a cancer is to be ruled out.