Hardacre Jeffrey M, Iacobuzio-Donahue Christine A, Sohn Taylor A, Abraham Susan C, Yeo Charles J, Lillemoe Keith D, Choti Michael A, Campbell Kurtis A, Schulick Richard D, Hruban Ralph H, Cameron John L, Leach Steven D
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287-4688, USA.
Ann Surg. 2003 Jun;237(6):853-8; discussion 858-9. doi: 10.1097/01.SLA.0000071516.54864.C1.
To compare the presentation and short-term results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis (LPSP) and pancreatic adenocarcinoma (PA) and to provide long-term follow-up on patients undergoing resection for LPSP.
LPSP is a rare form of chronic pancreatitis characterized by a mixed inflammatory infiltrate centered around pancreatic ducts and ductules, combined with obliterative phlebitis. Its presentation may mimic that of PA.
Among 1,648 patients undergoing pancreaticoduodenectomy at the authors' institution from January 1992 to May 2002, 37 with LPSP were identified. The demographics, clinical features, and short- and long-term outcomes of these patients were analyzed. Where applicable, comparisons were made to a consecutive group of 45 patients who underwent pancreaticoduodenectomy for PA from July 2001 to December 2001.
Twenty-four percent (9/37) of the LPSP patients and none of the PA patients had a history of either atopic or autoimmune disease. The LPSP patients had a similar clinical presentation to the PA patients, but the LPSP patients were less likely to have a discrete pancreatic mass on CT and more likely to have CT findings suggesting a diffusely enlarged pancreas. The LPSP patients were also less likely to have a discrete pancreatic mass at operation, more likely to have a diffusely firm or hard gland, and more likely to have a difficult portal vein/superior mesenteric vein dissection when compared to the PA patients. Transfusion requirement, operative time, postoperative length of stay, and overall complication rate were similar between groups; however, the LPSP patients had a greater operative blood loss. The median length of follow-up for LPSP patients was 33 months. No patients had recurrent jaundice. One patient with LPSP had clinically evident recurrent pancreatitis. Among LPSP patients available for current telephone interview, 68% subjectively rated their quality of life as better, 18% reported no change, and 14% reported diminished quality of life compared to before surgery.
LPSP mimics PA in clinical presentation, though CT findings of a diffusely enlarged pancreas without a discrete mass may suggest a diagnosis of LPSP. Nevertheless, differentiation from pancreatic neoplasia remains difficult. Patients undergoing pancreaticoduodenectomy for LPSP have durable relief of symptoms and a subjectively improved quality of life.
比较淋巴细胞浆细胞性硬化性胰腺炎（LPSP）和胰腺腺癌（PA）行胰十二指肠切除术的表现及短期结果，并对接受LPSP切除术的患者进行长期随访。
LPSP是一种罕见的慢性胰腺炎形式，其特征是围绕胰管和小导管的混合性炎症浸润，并伴有闭塞性静脉炎。其表现可能与PA相似。
在1992年1月至2002年5月期间在作者所在机构接受胰十二指肠切除术的1648例患者中，确定了37例LPSP患者。分析了这些患者的人口统计学、临床特征以及短期和长期结果。在适用的情况下，与2001年7月至2001年12月期间连续45例行PA胰十二指肠切除术的患者进行比较。
24%（9/37）的LPSP患者有特应性或自身免疫性疾病史，而PA患者均无此病史。LPSP患者的临床表现与PA患者相似，但LPSP患者在CT上出现孤立性胰腺肿块的可能性较小，而出现提示胰腺弥漫性肿大的CT表现的可能性较大。与PA患者相比，LPSP患者在手术时出现孤立性胰腺肿块的可能性也较小，出现胰腺弥漫性坚硬或硬变的可能性较大，进行门静脉/肠系膜上静脉解剖困难的可能性也较大。两组之间的输血需求、手术时间、术后住院时间和总体并发症发生率相似；然而，LPSP患者的术中失血量更大。LPSP患者的中位随访时间为33个月。没有患者出现复发性黄疸。1例LPSP患者出现临床明显复发的胰腺炎。在目前可进行电话访谈的LPSP患者中，68%主观认为其生活质量较术前有所改善，18%报告无变化，14%报告生活质量较术前下降。
LPSP在临床表现上与PA相似，尽管CT表现为胰腺弥漫性肿大而无孤立性肿块可能提示LPSP的诊断。然而，与胰腺肿瘤的鉴别仍然困难。接受LPSP胰十二指肠切除术的患者症状得到持久缓解，生活质量主观上有所改善。
