胰腺结石并发胰腺癌临床特征及诊断

《胰腺结石并发胰腺癌临床特征及诊断》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、胰腺结石并发胰腺癌临床特征及诊断作者：何振平，郑树国，王曙光，别平，马宽生【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

2、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ClinicalcharacteristicsanddiagnosisinpancreaticductstonesassociatedwithpancreaticcancerAbstactObjeciveToraisethelevelofdiagnosisandtreatmentforpancreaticduetstoneswithpancreaticcancer(PDSwithPC).MethodsSixty?Wsixpatientssufferedfrompancr

3、eaticduetstoneassociatedwithpancreaticcancerfrom1979to2005werereported.ResultsNinemenand2women.Fivecasesofwhomhadexcessivedrinking,5caseshadintestinalparasiticdisease,chiefsymptomsincludedabdominalandbackpain,obstruetionofbileduetandjaundiceandconsumecondition.ImagediagnosisunderBUS,CT,MRCP,ERCPsh

4、oweddilatationofpancreaticduetwithstoneorcalcificationanddilatationofbileduetorcysticenlargeaswellasenlargementofpancreas・Acasewithintraductaipapillarymucinousneoplasms(IPMN)ofthepancreasassociatedwithpancreaticcancerandcalcification.ConclusionDiagnosisofPDSwithPCisdifficult,diagnosticcluesofwhich

5、include：(DsymptomsexacerbatedinpatientswithPDSaged&It；50years；(Dpatientassociateswithobstruetionofbileductandjaundice；©imagediagnosisshoweddilatationofpancreaticductand/orcysticenlargementassociatedwithPDS,dilatationofbileduct,andenlargementofpancreas；④symptomsexacerbateprogressivelyafterpancreato

6、?郵jejunalanastomosisinthefollow?劉upstage；®patientswithIPMNandpancreaticstoneorcalcifica.tionhavetovigilancetoPC.Keywordspancreaticduetstone；pancreaticneoplasms；diagnosis胰管结石是慢性胰腺炎病程发展中的继发性病变，反过来进一步导致胰液淤滞与慢性炎症加剧，可发生胰腺囊肿、胰漏、顽固性腹痛、背痛，常伴有明显的胰内外分泌功能紊乱，甚至区域性门脉高压症、恶变等并发症［1］。胰管结石并发胰腺癌术前不易诊断，国内报道例数多为个案。我科1

7、989年6月〜2005年6月收治并手术治疗66例胰管结石，11例并发胰腺癌，现报告如下。1临床资料1.1一般资料11例中男性9例，女性2例，男：女为4.5:1；年龄为30〜75岁，平均为57.7岁。5例有酗酒史，5例有肠蛔虫史，2例有胰管空肠侧侧吻合手术史。1.2主要症状11例均有腹痛，10例伴腰背痛，6例有黄疸，2例有明显腹泻、消瘦，1例合并临床糖尿病。10例血糖升高。1.3影像诊断彩色多普勒超声11例均提示有慢性胰腺