摘要
目的探讨肿块型自身免疫性胰腺炎(AIP)的临床特点、治疗策略以及预后。方法收集国内资料完整的符合肿块型AIP诊断标准的45例病人结合我院诊治的一例进行研究分析,探讨该病的临床特点、诊断、治疗以及预后。结果男35例,女11例。好发年龄于50~60岁之间。常见的临床表现主要为梗阻性黄疸(70%)、上腹部不适或疼痛(52%)和消瘦乏力、发热等(17%)。43例接受血清学IgG4检查有30例升高。46例CA19-9检查中23例(50%)升高。影像学检查:46例中43例肿块位于胰头部(93%),3例位于胰体尾部(7%)。1例肿块型AIP患者行诊断性治疗确诊;21例行胰十二指肠切除术,3例行胰体尾切除术,术后病理诊断,患者术后未服用激素,随访未见复发;5例行胆肠吻合术,8例行剖腹探查+活检术,8例行EUS-FNA,病理诊断为AIP,予以激素治疗后肿块缩小或消失,其中6例患者复发,再次激素治疗后症状缓解。结论肿块型AIP好发于中老年男性,常以梗阻性黄疸就诊,血清学检查IgC4多有升高,病理学检查有助于诊断,激素治疗有效,复发再次激素治疗,症状仍能缓解。
Objective To explore the clinical characteristic and treatment strategy of autoimmune pancreatitis with mass pa-tients.Methods 46 cases of AIP with mass were reviewed retrospectively to study their clinical characteristic,diagnosis,treatment,and outcome.Results the main clinical manifestations are obstructive jaundice(70%),upper abdominal discomfort or pain(52%),emaciation and so on(17%).IgG4 has been detected among 43 cases,30 cases increased.CA19-9 have been examined in 46 cases,23(50%)cases are positive.Imaging examination findings implied that mass is mainly located in the head of pancreas(93%),only 7 percent is located in the tail of pancreas.One case of lump AIP was confirmed by diagnostic treatment;21 cases of pancreaticoduodenal resection,3 cases of pancreatic tail resetion,postoperative pathological confirmed,follow-up no recurrence;5 cases underwent biliary intestinal anastomosis,8 cases accepted laparotomy and biopsy,8 cases underwent EUS and FNA,pathological diagnosis of lump AIP,these patients accepted hormone therapy,the clinical symptoms were eased and the mass was shrink or disappear.But 6 cases were relapse,they were remission after using hormone again.Conclusions lump AIP often occurs in middle-aged men,most with obstructive jaundice,with IgG4 increasing,sensitive to hormone therapy,if relapse,hormone therapy was still effective.
出处
《肝胆外科杂志》
2022年第2期108-111,共4页
Journal of Hepatobiliary Surgery
关键词
自身免疫性胰腺炎
胰腺癌
诊断
治疗
autoimmune pancreatitis
pancreatic cancer
diagnosis
therapy
