胰腺结石并发胰腺癌的临床特征与诊断.docVIP

KKME---专业医学搜索引擎/ 胰腺结石并发胰腺癌的临床特征与诊断 作者：何振平,郑树国,王曙光 作者单位：(第三军医大学西南医院全军肝胆外科研究所，中国人民解放军西南肝胆外科医院，重庆 400038) 【摘要】 目的 提高胰管结石并发胰腺癌的诊治水平。 方法 报告1989～2005年66例胰管结石中并发胰腺癌11例的临床资料。 结果 男9例，女2例。5例有酗酒史，5例有肠蛔虫史，主要症状为腹痛、背痛、胆道梗阻、黄疸以及消耗症状。BUS，CT，MRCP，ERCP显示胰管扩张或囊性扩大伴有结石及钙化，胰腺肿大，胆管扩张，1例伴胰管内乳头状黏液瘤。 结论 胰管结石并发胰癌诊断困难，其诊断线索包括：① 50岁的胰管结石症伴症状近期加重者；②伴胆管梗阻与黄疸者；③影像诊断有胰管扩张，结石或钙化者，胆管扩张及胰腺肿大者；④随访胰管空肠吻合术后症状出现恶化者；⑤胰管内乳头状黏液瘤(IPMN)患者伴胰钙化者应警惕胰腺癌的并发。 【关键词】 胰管结石； 胰腺肿瘤； 诊断 Clinical characteristics and diagnosis in pancreatic duct stones associated with pancreatic cancer HE Zhenping， ZHENG Shuguo， WANG Shuguang， et al. Institute of Hepatobiliary Surgery, Southwest Hospital， the Third Military Medical University, Chongqing 400038 Abstact Objecive To raise the level of diagnosis and treatment for pancreatic duct stones with pancreatic cancer (PDS with PC). Methods Sixty?鄄six patients suffered from pancreatic duct stone associated with pancreatic cancer from 1979 to 2005 were reported. Results Nine men and 2 women. Five cases of whom had excessive drinking, 5 cases had intestinal parasitic disease, chief symptoms included abdominal and back pain, obstruction of bile duct and jaundice and consume condition. Image diagnosis under BUS, CT, MRCP, ERCP showed dilatation of pancreatic duct with stone or calcification and dilatation of bile duct or cystic enlarge as well as enlargement of pancreas. A case with intraductal papillary mucinous neoplasms (IPMN) of the pancreas associated with pancreatic cancer and calcification. Conclusion Diagnosis of PDS with PC is difficult， diagnostic clues of which include: ①symptoms exacerbated in patients with PDS aged 50 years; ②patient associates with obstruction of bile duct and jaundice; ③image diagnosis showed dilatation of pancreatic duct and/or cystic enlargement associated with PDS， dilatation of bile duct, and enlargement of pancreas; ④symptoms exacerbate progressively after pancreato?鄄jejunal anastomosis in the fo