计划性胰十二指肠切除术患者慢性淋巴浆细胞性硬化性胰腺炎的发病率及特征。
Incidence and characteristics of chronic and lymphoplasmacytic sclerosing pancreatitis in patients scheduled to undergo a pancreatoduodenectomy.
机构信息
Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam,the Netherlands.
出版信息
HPB (Oxford). 2010 Feb;12(1):15-21. doi: 10.1111/j.1477-2574.2009.00112.x.
BACKGROUND
The determination of the exact nature of a pancreatic head mass in a patient scheduled to undergo a pancreatoduodenectomy can be very difficult. This is important as patients who suffer from benign disease such as pancreatitis do not always require surgery. The aim of the present study was to analyse the incidence of pancreatitis and the signs and symptoms associated with these tumours mistaken for pancreatic cancer and the diagnostic procedures performed.
METHODS
A consecutive group of patients who underwent a pancreatoduodenectomy between 1992 and 2005 with histopathologically proven pancreatic adenocarcinoma (PCA) and pancreatitis were analysed.
RESULTS
The incidence of pancreatitis after pancreatoduodenectomy is 63 out of 639 patients who underwent a pancreaticoduodenectomy (9.9%). Of these patients, 24 patients (38%) had lymphoplasmacytic sclerosing pancreatitis (LPSP) and 31 patients (49%) had focal chronic pancreatitis. Eight patients (13%) had an intermediate form with characteristics of both. Pancreatic adenocarcinoma occurred in 227 patients (36%). The presence of pancreatitis without a discrete mass on endoscopic ultrasonography (EUS) seemed to have clinical relevance with a positive likelihood ratio of 5.1. Mortality after resection was nil in both groups.
CONCLUSION
The incidence of pancreatitis is 9.9% for patients scheduled to undergo a pancreatoduodenectomy. Of these patients, 38% had LPSP, 13% had a intermediate form and 49% had focal chronic pancreatitis. The determination of the exact nature of a pancreatic head mass remains difficult.
背景
在计划接受胰十二指肠切除术的患者中，确定胰头部肿块的确切性质可能非常困难。这一点很重要，因为患有胰腺炎等良性疾病的患者并不总是需要手术。本研究的目的是分析将这些肿瘤误诊为胰腺癌的胰腺炎发病率以及相关的体征和症状，以及所进行的诊断程序。
方法
对 1992 年至 2005 年间接受胰十二指肠切除术且组织病理学证实为胰腺腺癌（PCA）和胰腺炎的连续组患者进行分析。
结果
639 例行胰十二指肠切除术的患者中，术后发生胰腺炎的发生率为 63 例（9.9%）。其中，24 例（38%）患者为淋巴浆细胞性硬化性胰腺炎（LPSP），31 例（49%）为局灶性慢性胰腺炎。8 例（13%）患者为两者之间的中间型。227 例（36%）患者发生胰腺腺癌。在 EUS 上无离散性肿块时存在胰腺炎似乎具有临床意义，阳性似然比为 5.1。两组患者的切除术后死亡率均为零。
结论
计划接受胰十二指肠切除术的患者中，胰腺炎的发生率为 9.9%。其中，38%为 LPSP，13%为中间型，49%为局灶性慢性胰腺炎。确定胰头部肿块的确切性质仍然很困难。
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