肿块型慢性胰腺炎的诊治

Diagnosis and treatment of mass-type chronic pancreatitis

目的 总结肿块型慢性胰腺炎 (mass typechronicpancreatitis ,MTCP )的诊治经验 ,以提高对该病的认识。方法 回顾性分析近 8年来手术治疗的 2 5例MTCP患者的临床资料。 2 5例中行CT检查 2 3例 ,B超检查 2 1例 ,逆行胰胆管造影检查 (ERCP) 6例 ,超声内镜检查 (EUS) 5例 ,阳性发现率分别为 95 .7% ,85 .7% ,83 .3 % ,10 0 %。 2 5例均接受手术治疗 ,其中行胰十二指肠切除或保留幽门的胰十二指肠切除术 17例 ,保留十二指肠的胰头次全切除术 (Beger手术 ) 1例 ,胰头部分挖除、胰管空肠吻合术 (Freys手术 ) 3例。胰体尾部切除术 4例。 结果 上腹痛是MTCP的主要临床症状。肿块位于胰头部者 2 1例 (84.0 % ) ,胰体尾部者 4例 (16.0 % )。术前诊断为MTCP 16例 ,胰腺癌 9例。术后病理诊断为MTCP 2 2例 ,慢性胰腺炎合并胰腺癌 3例 ,术前误诊率 2 4.0 %。术后发生胰漏 1例 ,吻合口出血 2例 ,并发症发生率为 12 .0 %。术后近期 92 .0 %的患者腹痛缓解。 2 3例获 1～ 5年随访 ,平均随访 3 .4年 ,82 .6%的患者疗效满意。结论 MTCP应及早手术 ,多可获得满意疗效 ,并对减缓疾病进程有利。

Objective To summarize the experience of the diagnosis and treatment of mass-type chronic pancreatitis(MTCP) to improve the knowledge about MTCP. Methods The clinical data of tweent-five patients with MTCP undergoing operation in recent 8 years were analyzed retrospectively. The positive discovery rates with computed tomography(CT),ultrasonography(US),endoscopic retrograde cholangiopancreatography(ERCP),and endoscopic ultrasonography(EUS) were 95.7%,85.7%,83.3%,and 100%,respectively. All patients received operation,including pancreatoduodenectomy(15 cases),pancreatoduodenectomy with reservation of pylorus(2 cases),Beger′s procedure(1 case),Frey′s procedure(3 cases),and resection of pancreatic body and tail(4 cases). Results Upper quadrant abdominal pain is the main symptom of MTCP. Pancreatic masses were located in the head of pancreas in 21 cases(84.0%),in the body or tail in four cases(16.0%). 16 patients were diagnosed as MTCP and 9 diagnosed as pancreatic adenocarcinoma before operation. 22 patients were diagnosed as MTCP and 3 were diagnosed as chronic pancreatitis complicated with adenocarcinoma by pathology after operation.Preoperative misdiagnosis rate was 24.0%. Pain relieved immediately after operation in 92.0% of patients. One patients developed pancreatic leakage and two had anastomotic hemorrhage postoperatively,morbidity rate was 12.0%. 23 patients were followed-up for 1-5 years (mean 3.4 years). The therapeutic outcome was satisfactory in 82.6% of patients. Conclusions Operation should be performed as early as possible when the MTCP is diagnosed. It is effective to delay the progress of the disease.