以急性胰腺炎为首发表现的胰腺癌（附17例报告）

摘要/Abstract

摘要：

目的：探讨以急性胰腺炎为首发表现的胰腺癌病人临床及诊治特点。方法：回顾性分析2008年1月至2018年12月就诊于我院17例以急性胰腺炎为首发表现的胰腺癌病人临床表现、诊断和治疗。结果：本研究所有病人入院诊断均为轻型急性胰腺炎。主要表现为腹痛反复发作。大部分可见以CA199为主的肿瘤标志物升高。影像学检查可见胰腺占位、胰胆管扩张等。经手术病理检查确诊,11例诊断为胰腺导管腺癌,2例肝转移腺癌;4例细针穿刺活组织检查为腺癌。行以手术为主的综合治疗,其中5例胰十二指肠切除术,4例胰体尾切除术,2例全胰切除术,1例肝转移灶切除,1例胆囊切除+肝组织活检。结论：对急性胰腺炎病人应警惕胰腺恶性肿瘤的存在,需结合病史、实验室检查、影像学检查等综合判断,以便早期诊断,及时治疗。

关键词:胰腺癌,急性胰腺炎,临床特征

Abstract:

ObjectiveTo investigate the clinical features, diagnosis and treatment of pancreatic cancer with acute pancreatitis as first episode.MethodsIn this study we included 17 patients of pancreatic cancer with acute pancreatitis as first episode in our hospital from January 2008 to December 2018. Clinical data were reviewed retrospectively in terms of clinical presentation, diagnosis and treatment.ResultsAll the patients were admitted to hospital diagnosed as mild acute pancreatitis. Clinical manifestations were recurrent acute abdominal pain mostly. Laboratory tests showed that tumor mar-kers elevated especially CA199. Pancreatic mass and pancreaticobiliary dilatation were shown by imaging. The patients were diagnosed pathologically through surgery. Pancreatic ductal adenocarcinoma was in 11 cases, hepatic metastatic adenocarcinoma in 2 cases. Four cases were diagnosed as adenocarcinoma by fine needle aspiration biopsy. Comprehensive treatment was performed mainly with surgery including duodenopancreatectomy in 5 cases, resection of pancreatic body and tail in 4 cases, total pancreatectomy in 2 cases, resection of metastatic hepatic lesion in 1 case, and cholecystectomy with hepatic biopsy in 1 case.ConclusionsPatients with acute pancreatitis should be cautioned to the possibility of presence of pancreatic cancer. Comprehensive consideration is suggested through medical history reviewed combined with laboratory and imaging examination for the purpose of diagnosis and treatment as early as possible.

Key words:Pancreatic cancer,Acute pancreatitis,Clinical feature

中图分类号:

吴璟奕, 李国静, 费健. 以急性胰腺炎为首发表现的胰腺癌（附17例报告）[J]. 外科理论与实践, 2020, 25(04): 326-330.

WU Jingyi, LI Guojing, FEI Jian. Acute pancreatitis as first episode of pancreatic cancer: a report of 17 cases[J]. Journal of Surgery Concepts & Practice, 2020, 25(04): 326-330.

图/表3

项目	例数（%）	项目	例数（%）
临床表现		既往史
腹痛	16（94.1）	高血压史	4（23.5）
腰背部放射痛	4（23.5）	糖尿病史	1（5.9）
黄疸	4（23.5）	高脂血症史	1（5.9）
体重下降	6（35.3）	吸烟史	5（29.4）
上腹部压痛	11（64.7）	饮酒史	5（29.4）
反复发作	11（64.7）	AP严重程度分级
诱因		MAP	17（100）
进食油腻食物	4（23.5）
饮酒	3（21.4）

表1

表2

实验室及影像学检查（n=17）

项目	例数（%）
血清学检查
肿瘤标志物（CA199、CA125、CEA、 CA242、CA724）任意一项升高	13（76.5）
血淀粉酶升高	10（58.8）
空腹血糖升高	9（52.9）
肝酶（ALT、AST、γ-GT、AKP）任意一项升高	6（35.3）
总胆红素升高	4（23.5）
影像学检查
胰头占位	11（64.7）
胰体尾占位	6（35.3）
胰管扩张	15（88.2）
胆管扩张	8（47.1）
胰管截断	5（29.4）
阻塞性胰腺炎^a)	5（29.4）
胰源性门静脉高压	2（11.8）
胰尾部萎缩	2（11.8）
血管侵犯（包括腹腔干、肠系膜上下血管、腹腔动脉主干等）	7（41.2）
腹水	3（17.6）

表2

治疗	例数（%）	病理	例数（%）
保守治疗（化疗为主）	3（17.6）	类型
放弃手术治疗	1（5.9）	导管腺癌	11（64.7）
手术治疗	13（76.5）	TNM分期
胰十二指肠切除术^a)	5（29.4）	Ⅰ	6（35.3）
胰体尾切除术	4（23.5）	Ⅱ	3（17.6）
全胰切除术	2（11.8）	Ⅲ	4（23.5）
肝转移灶切除术	1（5.9）	Ⅳ	4（23.5）
胆囊切除术+ 肝结节组织活检	1（5.9）
术后化疗	8/13（61.5）

表3

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