van Gulik T M, Reeders J W, Bosma A, Moojen T M, Smits N J, Allema J H, Rauws E A, Offerhaus G J, Obertop H, Gouma D J
Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Gastrointest Endosc. 1997 Nov;46(5):417-23. doi: 10.1016/s0016-5107(97)70034-8.
The differentiation between cancer and benign disease in the pancreatic head is difficult. The aim of this study was to examine common features in a group of patients that had undergone pancreatoduodenectomy for a benign, inflammatory lesion misdiagnosed as pancreatic head cancer.
Among 220 pancreatoduodenectomies performed on the suspiscion of pancreatic head cancer, an inflammatory lesion in the pancreas or distal common bile duct was diagnosed in 14 patients (6%). Of these patients, all preoperative clinical information and radiologic images (ultrasound, endoscopic retrograde cholangio-pancreaticography [ERCP]) were critically reassessed. For each examination, the suspicion of cancer was scored on a 0/+/++ scale.
Clinical presentation (pain, weight loss, jaundice) raised a suspicion of cancer in 12 patients. On ultrasound, a tumor (mean size: 2.8 cm) was found in the pancreatic head in 13 patients; 12 of 14 ultrasound examinations raised a suspicion of cancer. ERCP showed a distal common bile duct stenosis (length: 1 to 4 cm), stenosis of the pancreatic duct (length: 1 to 5 cm), or a "double duct" stenosis, suspicious for cancer in 13 evaluable patients. The overall index of suspicion was + in seven patients and ++ in seven patients, confirming the initial interpretation of preoperative data.
When undertaking pancreatoduodenectomy for a suspicious lesion in the pancreatic head, it is necessary to expect at least a 5% chance of resecting a benign, inflammatory lesion masquerading as cancer.
胰腺头部癌症与良性疾病的鉴别诊断具有挑战性。本研究旨在探讨一组因误诊为胰腺头部癌症而接受胰十二指肠切除术的患者的共同特征，这些患者实际为良性炎症性病变。
在因怀疑胰腺头部癌症而进行的220例胰十二指肠切除术中，14例（6%）被诊断为胰腺或胆总管远端的炎症性病变。对这些患者的所有术前临床信息和影像学检查（超声、内镜逆行胰胆管造影[ERCP]）进行严格重新评估。每次检查时，根据0/+/++的评分标准对癌症的可疑程度进行评分。
临床表现（疼痛、体重减轻、黄疸）使12例患者被怀疑患有癌症。超声检查发现13例患者的胰腺头部有肿瘤（平均大小：2.8厘米）；14次超声检查中有12次提示癌症可疑。ERCP显示13例可评估患者存在胆总管远端狭窄（长度：1至4厘米）、胰管狭窄（长度：1至5厘米）或“双管”狭窄，提示癌症可疑。总体可疑指数为+的患者有7例，++的患者有7例，证实了术前数据的初步判断。
当对胰腺头部可疑病变进行胰十二指肠切除术时，必须考虑到至少有5%的可能性切除的是伪装成癌症的良性炎症性病变。
