自身免疫性胰腺炎的诊断与外科治疗

Diagnosis and surgical treatment of autoimmune pancreatitis

目的探讨自身免疫性胰腺炎外科治疗的指征并评价其疗效。方法回顾性分析2010—2021年北京大学第一医院普通外科诊治的15例不典型自身免疫性胰腺炎患者的临床资料。结果15例患者临床症状主要表现为梗阻性黄疸、腹痛、腹胀、消瘦等。6例经超声内镜引导下细针穿刺活检明确诊断,其中口服激素治疗后4例均未再复发,2例未行相关治疗,其中1例1年后新发胃癌。9例因未能排除恶性病变而行手术治疗并获得病理诊断。1例行开腹探查+胰腺活检术患者术后口服激素治疗未见复发;3例胆肠吻合手术患者术后口服激素治疗,于术后3年复发1例;行胰腺切除手术的5例患者中,4例无明确复发,1例于术后3年复发。结论临床表现不典型的自身免疫性胰腺炎易误诊为胰腺占位性病变。对于激素治疗效果欠佳、症状持续存在及难以排除恶性者,手术治疗有可能使患者获益。

Objective To explore the indications and effect of surgical treatment of autoimmune pancreatitis.Methods Clinical data of these 15 patients with autoimmune pancreatitis diagnosed and treated at the Department of General Surgery,the First Hospital of Peking University from 2010 to 2021 were retrospectively analyzed.Results The main clinical symptoms were obstructive jaundice,abdominal pain,distension and weight loss.The diagnosis of AIP was confirmed by EUS-FNA in 6 patients,among them,4 did not relapse after oral hormone treatment,2 did not receive relevant treatment,and 1 developed gastric cancer one year later.Under a suspicion of malignancy,9 patients underwent surgical laparotomy,and the diagnosis was established by pathology.There was no recurrence after oral hormone therapy in 1 patient who underwent laparotomy and pancreatic biopsy.One out of the 3 patients with choledochojejunostomy relapsed after 3 years.Of the 5 patients who underwent pancreatectomy,4 had no obvious recurrence,and 1 had recurrence after 3 years.Conclusions Untypical autoimmune pancreatitis is likely to be misdiagnosed as pancreatic cancer.For patients with suspicious malignancy,operational management and biopsy may benefit.