左下腹痛与胰腺癌的特殊临床表现的论文.docVIP

　　左下腹痛与胰腺癌的特殊临床表现的论文 【摘要】 目的 上腹痛是胰腺癌患者的主要表现之一，但极少数患者可能以其他部位腹痛为主诉。本文通过分析2例 以左下腹痛为主诉的胰腺癌患者的临床特征，目的在于提高胰腺癌的诊断水准。 方法 以蛋白质芯片技术检测ca19-9等 肿瘤标记，b超检查胰腺等上腹部脏器，螺旋ct胰腺薄层扫描，以及进行内镜下逆行胰胆管x线造影（ercp）等。发现胰腺 占位之后，患者转至外科行剖腹探查，采取胰腺病灶和转移结节标本，做病理学组织检查。 结果 以左下腹痛为主诉的2例 胰腺癌患者ca19-9显著增高;b超和ct显示胰腺体、尾部占位，肝内多发转移灶以及后腹膜淋巴结肿大;手术证实胰腺体、 尾部肿瘤浸润，腹膜、肝脏、肝十二指肠韧带、肠系膜根部、盆腔等处见多个大小不等的结节。术后病理报告为腺癌。 结论 极少数胰腺体、尾部癌患者可能以左下腹痛为主要临床表现。因此，在注意胰腺癌的典型表现的同时，也应加强对那些腹部 症状不典型，但有胰腺癌发病易感因素的患者的警惕性，运用有效的检查方法，实现胰腺癌的早期诊断和早期治疗。　　【关键词】 胰腺癌;诊断 　　pancreatic cancer predominated by pain in the left lo of the ab- domen 　　chen mei-mei，chen guang-yu，dong guo-fang，et al. 　　department of gastroenterology，xinhua hospital， shanghai second medical university，shanghai 200092，china 　　【abstract】 objective epigastric pain is one of the major clinical manifestations of the patient e cases may e to consultation - inal areas.the author analysed the clinical features of 2 cases inated by pain in the left lo of the abdomen，in order to promote the diagosis of the disease. methods ca19-9，to- gether or markers，ined ode ultrasonography and high-speed spiral puted tomography （ct） ployed for detection of pancreas and other abdominal organs.endo- scopic retrograde chologiopancreatography （ercp） ed to have occupied pancreatic lesions， they ent for abdominal exploration and samples of the pan- creatic tumor，along phnodes are taken out for histopathology. results serum ca19-9 in- creased significantly in both of the 2 patients. b-mode ultrasonography and ct demonstrated occupied lesions in the body or tail of the pancreas as phadenectasis or multiple matastasis foci in the liv- er.upon surgical operation，infiltrated malignant tumors atastasis foci in different size on the peritonum，the liver，hepatoduodenal ligment，root of mesenterium and pel- vic cavity.and pancreatic adenocarcinoma ed by histopathology. conclusion very occasionally a feinated by pain in the left lo of the abdomen.great at- tention should be paid not only to typical clinical manifestations of