From the Department of Surgery.
Division of Gastroenterology and Hepatology, Department of Medicine.
Pancreas. 2021 Apr 1;50(4):556-563. doi: 10.1097/MPA.0000000000001812.
The aim of this study was to critically analyze the surgical experience of managing autoimmune pancreatitis (AIP) in an era of modern diagnostics and compare these patients with those who were managed conservatively.
Two prospectively maintained databases were used to retrospectively identify patients with AIP who were either managed conservatively or underwent pancreatectomy.
Eighty-eight patients were included in the study, of which 56 (63.6%) underwent resection and 32 (36.4%) were managed conservatively. Patients who underwent resection were more likely to present with jaundice (64.3% vs 18.1%, P < 0.001) and weight loss (53.6% vs 15.6%, P = 0.005). The cohort who underwent resection had a significantly higher median carbohydrate antigen 19-9 (40.0 vs 18.6 U/mL, P = 0.034) and was less likely to have elevated immunoglobulin G4 (26.1% vs 50.0%, P < 0.001). The most frequent initial diagnosis in the cohort who underwent resection was ductal adenocarcinoma (82.1%). Nine patients (28.1%) in the conservatively managed cohort experienced AIP relapse compared with 6 patients (10.7%) in the cohort who underwent resection.
The most frequent reason for surgical resection of AIP is concern for malignancy. Carbohydrate antigen 19-9 elevations were more common than immunoglobulin G4 in our cohort, suggesting that this laboratory profile is suboptimal for this population.
本研究旨在批判性地分析在现代诊断时代管理自身免疫性胰腺炎（AIP）的手术经验，并将这些患者与接受保守治疗的患者进行比较。
使用两个前瞻性维护的数据库回顾性地确定接受保守治疗或接受胰切除术的 AIP 患者。
研究纳入 88 例患者，其中 56 例（63.6%）接受了切除术，32 例（36.4%）接受了保守治疗。接受切除术的患者更可能出现黄疸（64.3% vs 18.1%，P < 0.001）和体重减轻（53.6% vs 15.6%，P = 0.005）。接受切除术的患者中位碳水化合物抗原 19-9 水平显著升高（40.0 与 18.6 U/mL，P = 0.034），且 IgG4 升高的可能性较小（26.1% vs 50.0%，P < 0.001）。接受切除术的患者中最常见的初始诊断是导管腺癌（82.1%）。接受保守治疗的患者中有 9 例（28.1%）发生 AIP 复发，而接受切除术的患者中有 6 例（10.7%）。
AIP 手术切除的最常见原因是担心恶性肿瘤。在我们的队列中，碳水化合物抗原 19-9 升高比 IgG4 更常见，这表明该实验室特征对该人群不太理想。
