沟状胰腺炎：一种具有伪装性但独特的临床病理实体——危险因素分析与鉴别诊断

Groove Pancreatitis, a Masquerading Yet Distinct Clinicopathological Entity: Analysis of Risk Factors and Differentiation.

作者信息

Oza Veeral M, Skeans Jacob M, Muscarella Peter, Walker Jon P, Sklaw Brett C, Cronley Kevin M, El-Dika Samer, Swanson Benjamin, Hinton Alice, Conwell Darwin L, Krishna Somashekar G

机构信息

From the *Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, †Department of Surgery, and ‡Department of Pathology, The Ohio State University Wexner Medical Center; and §Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH.

出版信息

Pancreas. 2015 Aug;44(6):901-8. doi: 10.1097/MPA.0000000000000351.

DOI:10.1097/MPA.0000000000000351

PMID:25899649

Abstract

OBJECTIVES

Our objective was to delineate predictive factors differentiating groove pancreatitis (GP) from other lesions involving the head of the pancreas (HOP).

METHODS

A case-control study of patients older than 10 years was performed comparing patients with GP to those with other surgically resected HOP lesions.

RESULTS

Thirteen patients with GP (mean ± SD age, 51.9 ± 10.5 years; 11 males [84.6%]), all with a history of smoking (mean, 37.54 ± 17.8 pack-years), were identified. Twelve patients (92.3%) had a history of heavy alcohol drinking (heavy alcohol [EtOH]). The mean lesion size was 2.6 ± 1.1 cm, and the CA 19-9 was elevated (>37 IU/mL) in 5 patients (45.5%). The most common histopathologic condition was duodenal wall cyst with myofibroblastic proliferation and changes of chronic pancreatitis in the HOP.Univariate analysis revealed decreasing age, male sex, weight loss, nausea/vomiting, heavy EtOH, smoking, and a history of chronic pancreatitis were predictive of GP. A multivariate analysis among smokers demonstrated that weight loss (P = 0.006; odds ratio, 11.96; 95% confidence interval, 2.1-70.2), and heavy EtOH (P < 0.001; odds ratio, 82.2; 95% confidence interval, 9.16-738.1) were most predictive of GP. Compared to pancreatic adenocarcinoma (n = 183), weight loss and heavy EtOH remained predictive of GP.

CONCLUSION

Groove pancreatitis in the HOP is associated with a history of heavy EtOH and weight loss. In the absence of these symptoms, it is essential to rule out a malignant lesion.

摘要

目的

我们的目的是明确区分沟部胰腺炎（GP）与其他累及胰头（HOP）病变的预测因素。

方法

对10岁以上患者进行病例对照研究，将GP患者与其他接受手术切除的HOP病变患者进行比较。

结果

共识别出13例GP患者（平均±标准差年龄，51.9±10.5岁；11例男性[84.6%]），所有患者均有吸烟史（平均，37.54±17.8包年）。12例患者（92.3%）有大量饮酒史（大量乙醇[EtOH]）。平均病变大小为2.6±1.1 cm，5例患者（45.5%）的CA 19-9升高（>37 IU/mL）。最常见的组织病理学情况是十二指肠壁囊肿伴肌成纤维细胞增生以及HOP处慢性胰腺炎改变。单因素分析显示年龄减小、男性、体重减轻、恶心/呕吐、大量EtOH、吸烟以及慢性胰腺炎病史是GP的预测因素。对吸烟者进行多因素分析表明，体重减轻（P = 0.006；比值比，11.96；95%置信区间，2.1 - 70.2）和大量EtOH（P < 0.001；比值比，82.2；95%置信区间，9.16 - 738.1）是GP最具预测性的因素。与胰腺腺癌（n = 183）相比，体重减轻和大量EtOH仍然是GP的预测因素。