Gronen G, Dombrowski H, Adler G, Lorenz-Meyer H
Z Gastroenterol. 1986 Aug;24(8):416-25.
174 patients with chronic pancreatic diseases, 30 patients with pancreatic carcinoma and 144 with chronic relapsing pancreatitis, 50 of them with calcifications, were observed in the Department of Internal Medicine of the University of Marburg/FRG between 1972 and 1982. In order to differentiate between carcinoma and relapsing pancreatitis the data of these patients were analysed retrospectively with regard to patient history, actual complaints, findings of laboratory, sonography, ERCP and X-ray investigations. The following results were obtained: Of discriminating value are steatorrhoe, local palpatory pain, alcohol ingestion, a history of earlier attacks and relapsing pain situations; however, general abdominal pain, nausea, vomiting and weight loss (if not exactly specified) are not. Within the laboratory findings bilirubin, GOT, alkaline phosphatase, gamma-GT, serum potassium, blood sugar and chymotrypsin content of the stool were significant while serum and urine amylase were similarly distributed within the groups of patients. Carcinoma and chronic relapsing pancreatitis can be identified by sonography in the majority of patients, but calcifications of the pancreas were rarely demonstrated during this observation period. The obstruction of the extrahepatic bile ducts--mostly due to a carcinoma of the pancreas head--was usually well documented by sonography. Intraabdominal air proofed to be the most disturbing factor. In carcinoma patients, the ERCP is important in demonstrating a complete obstruction of the pancreatic duct and stenosis and dilatation of the extrahepatic bile ducts. In patients with chronic relapsing pancreatitis the pancreatic duct alterations such as dilatations and partial stenosis are well documented by ERCP especially if calcifications occur. In patients without calcifications, dilatation of the branches of the main duct are less relevant in the diagnosis of pancreatic diseases. Radiological demonstration of calcification of the pancreatic area is important for the differential diagnosis. Longstanding characteristical complaints, symptoms and calcifications within the pancreatic area are the most relevant factors in discriminating carcinoma and chronic relapsing pancreatitis.
1972年至1982年间，德国马尔堡大学内科对174例慢性胰腺疾病患者、30例胰腺癌患者和144例慢性复发性胰腺炎患者进行了观察，其中50例慢性复发性胰腺炎患者有钙化。为了区分癌症和复发性胰腺炎，对这些患者的数据进行了回顾性分析，涉及患者病史、当前症状、实验室检查、超声检查、内镜逆行胰胆管造影（ERCP）和X线检查结果。得到以下结果：脂肪泻、局部触痛、饮酒、既往发作史和复发性疼痛情况具有鉴别价值；然而，一般性腹痛、恶心、呕吐和体重减轻（如果未明确说明）则不然。在实验室检查结果中，胆红素、谷草转氨酶（GOT）、碱性磷酸酶、γ-谷氨酰转肽酶（gamma-GT）、血清钾、血糖和粪便糜蛋白酶含量具有显著意义，而血清和尿淀粉酶在患者组中的分布相似。超声检查可在大多数患者中鉴别出癌症和慢性复发性胰腺炎，但在此观察期间很少发现胰腺钙化。肝外胆管梗阻——主要由于胰头癌——通常通过超声检查得到很好的记录。腹腔内气体被证明是最干扰因素。在癌症患者中，ERCP对于显示胰管完全梗阻以及肝外胆管狭窄和扩张很重要。在慢性复发性胰腺炎患者中，ERCP可以很好地记录胰管改变，如扩张和部分狭窄，尤其是在有钙化的情况下。在无钙化的患者中，主胰管分支扩张在胰腺疾病诊断中相关性较小。胰腺区域钙化的放射学显示对鉴别诊断很重要。长期存在的典型症状、体征和胰腺区域钙化是鉴别癌症和慢性复发性胰腺炎的最相关因素。
