中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2015年
8期
659-662
,共4页
郑鹏%崔云龙%周洪渊%陈璐%周远达%李强
鄭鵬%崔雲龍%週洪淵%陳璐%週遠達%李彊
정붕%최운룡%주홍연%진로%주원체%리강
自身免疫性胰腺炎%诊断%治疗
自身免疫性胰腺炎%診斷%治療
자신면역성이선염%진단%치료
Autoimmune pancreatitis%Diagnosis%Therapy
目的 探讨自身免疫性胰腺炎(AIP)的诊断与治疗.方法 回顾性分析2009年1月至2013年12月天津医科大学肿瘤医院收治的25例AIP患者的临床资料.检测患者血清γ球蛋白、IgG4,并行腹部影像学检查.诊断标准参照美国HISORt诊断标准或术后病理学检查结果.难以耐受手术的患者口服泼尼松治疗.术前影像学检查明确胰腺肿块,但无法明确肿块性质,不能完全排除恶性肿瘤,激素治疗无效,能够耐受手术的患者行手术治疗.采用门诊和电话方式进行随访,随访时间截至2014年12月.结果 首发症状:黄疸16例,体质量明显减轻(体质量减轻＞10％标准体质量)4例,慢性腹泻(腹泻持续时间＞2个月或间歇期为2～4周的复发性腹泻)3例,腹痛2例.血清y球蛋白异常13例,IgG4升高1例.影像学检查示胰腺肿块19例,胆管狭窄6例;有胰腺外器官受累11例.25例AIP患者中,10例行保守治疗;15例行手术治疗,其中13例行胰十二指肠切除术,2例行胰体尾联合脾切除术.10例保守治疗患者未出现不良反应.15例手术患者手术时间为(271±59) min,术中出血量为(268±109) mL,术后胃肠功能恢复时间为(3.8±1.2)d.术后2例患者发生腹腔感染,其中1例发生胰瘘,1例发生胃排空障碍,予对症治疗后缓解.15例手术患者术后住院时间为(11.5 ±2.9)d.术后病理学检查:胰腺中心性腺泡萎缩,广泛性纤维化,伴淋巴浆细胞浸润,神经组织被淋巴浆细胞包绕,闭塞性静脉炎,IgG4阳性细胞绝对值＞50个/高倍视野,IgG4阳性细胞数＞40％ IgG阳性细胞数.25例患者均获得随访,中位随访时间为27个月(6 ～47个月).19例患者治疗6个月症状缓解,其中保守治疗患者7例,手术治疗患者12例,血清γ球蛋白和IgG4正常,胰腺肿块无复发.结论 AIP临床表现为黄疸、血清γ球蛋白异常,影像学检查示胰腺肿块.外科手术治疗AIP安全、有效,但鉴于手术本身的创伤,应严格把握适应证.
目的 探討自身免疫性胰腺炎(AIP)的診斷與治療.方法 迴顧性分析2009年1月至2013年12月天津醫科大學腫瘤醫院收治的25例AIP患者的臨床資料.檢測患者血清γ毬蛋白、IgG4,併行腹部影像學檢查.診斷標準參照美國HISORt診斷標準或術後病理學檢查結果.難以耐受手術的患者口服潑尼鬆治療.術前影像學檢查明確胰腺腫塊,但無法明確腫塊性質,不能完全排除噁性腫瘤,激素治療無效,能夠耐受手術的患者行手術治療.採用門診和電話方式進行隨訪,隨訪時間截至2014年12月.結果 首髮癥狀:黃疸16例,體質量明顯減輕(體質量減輕＞10％標準體質量)4例,慢性腹瀉(腹瀉持續時間＞2箇月或間歇期為2～4週的複髮性腹瀉)3例,腹痛2例.血清y毬蛋白異常13例,IgG4升高1例.影像學檢查示胰腺腫塊19例,膽管狹窄6例;有胰腺外器官受纍11例.25例AIP患者中,10例行保守治療;15例行手術治療,其中13例行胰十二指腸切除術,2例行胰體尾聯閤脾切除術.10例保守治療患者未齣現不良反應.15例手術患者手術時間為(271±59) min,術中齣血量為(268±109) mL,術後胃腸功能恢複時間為(3.8±1.2)d.術後2例患者髮生腹腔感染,其中1例髮生胰瘺,1例髮生胃排空障礙,予對癥治療後緩解.15例手術患者術後住院時間為(11.5 ±2.9)d.術後病理學檢查:胰腺中心性腺泡萎縮,廣汎性纖維化,伴淋巴漿細胞浸潤,神經組織被淋巴漿細胞包繞,閉塞性靜脈炎,IgG4暘性細胞絕對值＞50箇/高倍視野,IgG4暘性細胞數＞40％ IgG暘性細胞數.25例患者均穫得隨訪,中位隨訪時間為27箇月(6 ～47箇月).19例患者治療6箇月癥狀緩解,其中保守治療患者7例,手術治療患者12例,血清γ毬蛋白和IgG4正常,胰腺腫塊無複髮.結論 AIP臨床錶現為黃疸、血清γ毬蛋白異常,影像學檢查示胰腺腫塊.外科手術治療AIP安全、有效,但鑒于手術本身的創傷,應嚴格把握適應證.
목적 탐토자신면역성이선염(AIP)적진단여치료.방법 회고성분석2009년1월지2013년12월천진의과대학종류의원수치적25례AIP환자적림상자료.검측환자혈청γ구단백、IgG4,병행복부영상학검사.진단표준삼조미국HISORt진단표준혹술후병이학검사결과.난이내수수술적환자구복발니송치료.술전영상학검사명학이선종괴,단무법명학종괴성질,불능완전배제악성종류,격소치료무효,능구내수수술적환자행수술치료.채용문진화전화방식진행수방,수방시간절지2014년12월.결과 수발증상:황달16례,체질량명현감경(체질량감경＞10％표준체질량)4례,만성복사(복사지속시간＞2개월혹간헐기위2～4주적복발성복사)3례,복통2례.혈청y구단백이상13례,IgG4승고1례.영상학검사시이선종괴19례,담관협착6례;유이선외기관수루11례.25례AIP환자중,10례행보수치료;15례행수술치료,기중13례행이십이지장절제술,2례행이체미연합비절제술.10례보수치료환자미출현불량반응.15례수술환자수술시간위(271±59) min,술중출혈량위(268±109) mL,술후위장공능회복시간위(3.8±1.2)d.술후2례환자발생복강감염,기중1례발생이루,1례발생위배공장애,여대증치료후완해.15례수술환자술후주원시간위(11.5 ±2.9)d.술후병이학검사:이선중심성선포위축,엄범성섬유화,반림파장세포침윤,신경조직피림파장세포포요,폐새성정맥염,IgG4양성세포절대치＞50개/고배시야,IgG4양성세포수＞40％ IgG양성세포수.25례환자균획득수방,중위수방시간위27개월(6 ～47개월).19례환자치료6개월증상완해,기중보수치료환자7례,수술치료환자12례,혈청γ구단백화IgG4정상,이선종괴무복발.결론 AIP림상표현위황달、혈청γ구단백이상,영상학검사시이선종괴.외과수술치료AIP안전、유효,단감우수술본신적창상,응엄격파악괄응증.
Objective To investigate the diagnosis and treatment of autoimmune pancreatitis (AIP).Methods The clinical data of 25 patients with AIP who were admitted to the Cancer Hospital of Tianjin Medical University between January 2009 and December 2013 were retrospectively analyzed.Patients received the test of serum γ-globulin and IgG4 and abdominal imaging examination.The revised HISORt or results of postoperative pathological examination were performed as diagnostic criteria.Patients who were unable to tolerate surgery were treated by oral prednisone.The focal masses were apparent in the pancreas by imaging examination,which cannot exclude the possibility of malignancy because of ambiguous pathologic characters of masses.Patients who received ineffective hormonal therapy and were able to tolerate surgery underwent surgery.All the patients were followed up by outpatient examination and telephone interview up to December 2014.Results Primary symptoms:jaundice was detected in 16 patients,obvious weight loss (weight loss ＞ 10％ standard body mass) in 4 patients,chronic diarrhea (duration of diarrhea ＞ 2 months or 2 weeks ＜ duration of intermittent diarrhea ＜ 4 weeks) in 3 patients and abdominal pain in 2 patients.Abnormal level of serum γ-globulin and increasing level of IgG4 were detected in 13 and 1 pateints.The results of imaging examinations showed that pancreatic masses,stenosis of bile duct and extrapancreactic organ involvement were detected in 19,6 and 11 patients.Of 25 patients with AIP,10 underwent conservative treatment without adverse reaction and 15 underwent surgical treatment,including 13 of 15 patients undergoing pancreaticoduodenectomy and 2 of 15 patients undergoing resection of the body and tail of the pancreas + splenectomy.The operation time,volume of intraoperative blood loss and postoperative recovery time of gastrointestinal function in 15 patients undergoing surgery were (271 ±59) minutes,(268 ± 109) mL and (3.8 ± 1.2)days.After operation,2 patients were complicated with abdominal infection and had remission of symptoms by symptomatic treatment,including 1 with pancreatic fistula and 1 with delayed gastric emptying.The duration of hospital stay of 15 patients undergoing surgery was (11.5 ± 2.9)days.The results of postoperative pathological examination showed that there were central acinar atrophy,extensive fibrosis,lymphoplasmacytic cell infiltration,nerve tissue surrounded by the plasma cell lymphoma and obstructive phlebitis.The absolute value of positive cells of IgG4 was more than 50 high power field and number of positive cells of IgG4 was more than positive cells of 40％ IgG.Twenty-five patients were followed up for a median time of 27 months (range,6-47months).Nineteen patients had remission of symptoms at month 6 after treatment with normal level of serum γ-globulin and IgG4 and without recurrence of pancreatic masses,including 7 receiving conservative treatment and 12 receiving surgical treatment.Conclusions The clinical signs of AIP are jaundice,abnormal serum γglobulin and pancreatic masses which are found by imaging examination.Surgery is safe and effective for the treatment of AIP,while surgical indications should be strictly followed because of the surgical trauma.
