胰頭肿块型胰腺炎的诊治分析.doc

KKME---专业医学搜索引擎/ 胰头肿块型胰腺炎的诊治分析 作者：赵勇 作者单位：哈尔滨医科大学第一临床医学院 普外一科，黑龙江 哈尔滨 150001 【摘要】 目的 总结分析胰头肿块型胰腺炎的诊断和治疗方法。方法 回顾性分析我院1998年2月至2007年2月间收治的175例慢性胰腺炎病例，总结其中16例因胰头占位，术前难以与胰腺癌进行鉴别而行胰十二指肠切除术患者的病例资料。本组中有饮酒史者12例，慢性胆囊炎史者4例。因梗阻性黄疸入院者11例，因腹痛入院者5例。诊断方法包括肿瘤标志物、B超、CT、ERCP等。结果 16例患者术中探查均显示肿块位于胰头，与周围组织有粘连，其中1例与门静脉有粘连，但尚能剥离，术后病理证实均为慢性胰腺炎。结论 目前区分慢性胰腺炎与胰腺癌尚无特异性好和敏感性高的鉴别诊断方法，CT结合ERCP对大部分病例的鉴别诊断具有较高的价值，对于胰头肿块型胰腺炎行胰十二指肠切除术可以达到较好的治疗效果。 【关键词】 胰腺炎 胰腺肿瘤 诊断 治疗 Diagnosis and treatment of chronic pancreatitis with mass in head of pancreas ZHAO Yong， DAI Wenjie， JIANG Hongchi. The First Department of General Surgery， the First Affiliated Hospital， Harbin Medical University， Harbin 150001 Abstract Objective To summarize the experiences of our hospital in diagnosis and treatment of chronic pancreatitis with mass in head of pancreas. Methods One hundred and seventy five patients with chronic pancreatitis treated in our hospital from February 1998 to February 2007 were reviewed. Sixteen patients of the received Whipple procedure because of difficult preoperative differential diagnosis between pancreatic cancer and chronic pancreastitis were summarized. Results The etiological factors in these group of patients were alcohol consumption (12)， chronic cholecystitis (4). Before admission， 11 patients complained obstructive jaundice and the other 5 abdominal pain. The diagnostic methods included serological marker determination， B-mode ultrasonography， CT and ERCP. The exploration showed that the mass was located in the head of the pancreas. Sixteen patients had around-tissue adhesion and 1 single adhesion with vena portae. Pathological examination indicated that 16 patients suffered from chronic pancreatitis. Conclusion There is limitation to differentiate the two diseases. ERCP in combination with CT is the most sensitive method for distinguishing a neoplasm from chronic pancreatitis and Whipple procedure is a good approach for chronic pancreastitis treatm