胰管結石合并胰腺癌10例診治回顧分析_《中國普外基礎與臨床雜志》

作者：

楊威 , 鄭鑫 , 劉青光 , 姚英民 , 于良

西安交通大學醫學院附屬第一醫院肝膽外科(西安 710061);

關鍵詞：

胰腺結石腫瘤

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目的探討胰管結石與胰腺癌的關系以及胰管結石伴發胰腺癌的臨床特點、診斷及治療。
方法回顧性總結分析1992年3月至2007年9月期間我院收治的10例胰管結石合并胰腺癌患者的臨床資料。
結果本組病例多以上腹部疼痛為首發癥狀(8/10)，缺乏特異性癥狀； B型超聲和CT診斷陽性者分別為4例（4/10）和6例（6/10），ERCP診斷陽性者為5例（5/5）；術前確診7例（7/10），疑診2例，漏診1例。10例患者中8例行胰十二指腸切除術，1例行活檢術，1例由于漏診行胰管切開取石、胰管空腸吻合術。
結論多種診斷方法聯合應用可提高胰管結石合并胰腺癌診斷的準確率，但目前該病的術前診斷陽性率不高，應常規行術中病理學檢查；其首選術式為胰十二指腸切除術。

引用本文： 楊威,鄭鑫,劉青光,姚英民,于良. 胰管結石合并胰腺癌10例診治回顧分析. 中國普外基礎與臨床雜志, 2009, 16(2): 141-144. doi: 復制

1.	1張國偉，周杰，李朝龍,等.胰石癥的診斷與治療體會(附16例報告) [Ｊ]. 中華肝膽外科雜志， 2003； 9 (11)： 648 2李建水，張肇達，唐勇，等. 胰管結石的臨床分析 [Ｊ]. 中國普外基礎與臨床雜志,2006; 13(4)： 456.
2.	10Paulino-Netto A, Dreiling DA, Baronofsky ID. The relationship between pancreatic calcification and cancer of the pancreas [Ｊ]. Ann Surg,1960; 151(4)： 530 11Machiki Y, Nimura Y, Kamiya J,et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones [Ｊ]. Int J Pancreatol,1997; 22(3)： 187.
3.	Saraya A, Acharya SK, Vashist S, et al. A pancreatography study of chronic calcific pancreatitis of the tropics [Ｊ]. Trop Gastroenterol,2002; 23(4)： 167.
4.	熊先澤，敬靜，彭其芳. 胰管結石慢性胰腺炎的診治 [Ｊ]. 中國普外基礎與臨床雜志,2007; 14（1）： 94.
5.	Patard L,Lallemand JY,Stoven V.An insight into the role of human pancreatic lithostathine [Ｊ]. JOP,2003; 4(2)： 92.
6.	Jin CX, Naruse S, Kitagawa M,et al. Pancreatic stone protein of pancreatic calculi in chronic calcified pancreatitis in man [Ｊ]. JOP,2002; 3(2)： 54.
7.	Nakamura M, Oka M, Iizuka N, et al. Osteopontin expression in chronic pancreatitis [Ｊ]. Pancreas,2002; 25(2)： 182.
8.	Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis [Ｊ]. Digestion,1998; 59 Suppl 4： 49.
9.	Nagai H, Ohtsubo K. Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis [Ｊ]. Gastroenterology,1984; 86(2)： 331.
10.	何振平, 鄧有松, 馬寬生, 等. 胰管結石與并發胰腺癌 [Ｊ]. 中華肝膽外科雜志,2002; 8(2)： 90.
11.	Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status [Ｊ]. AJR Am J Roentgenol,1995; 165(5)： 1175.
12.	Procacci C, Graziani R, Bicego E, et al.Intraductal mucin-producing tumors of the pancreas: imaging findings [Ｊ]. Radiology,1996; 198(1)： 249.
13.	Kahl S, Glasbrenner B, Zimmermann S,et al. Endoscopic ultrasound in pancreatic diseases [Ｊ]. Dig Dis,2002; 20(2)： 120〖ＺＫ).
14.	Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [Ｊ]. Cancer, 1992; 70(11)： 2610.
15.	劉訓良, 杜競輝, 戴存才，等.胰液細胞學檢查與PCR-SSP診斷胰腺癌之比較 [Ｊ]. 中華肝膽外科雜志, 1999; 5(2)： 106.
16.	Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [Ｊ]. Hepatogastroenterology, 1999; 46(25)： 31.
17.	周國雄，黃介飛，張弘，等. 內鏡下胰液收集及腫瘤標記物檢測對胰腺癌的診斷價值 [Ｊ].臨床內科雜志,2005;22(6)： 397.
18.	Tada M, Komatsu Y, Kawabe T, et al. Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor [Ｊ]. Am J Gastroenterol,2002; 97(9)： 2263.
19.	Liu F, Li ZS, Xu GM, et al. Detection of K-ras gene mutation at codon 12 by pancreatic duct brushing for pancreatic cancer [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(2)： 313.
20.	Yu XJ, Long J, Fu DL, et al. Analysis of gene expression profiles in pancreatic carcinoma by using cDNA microarray [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(3)： 467.
21.	Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success [Ｊ]. Gastrointest Endosc,2002; 56(4)： 501.
22.	Ozkan H, Kaya M, Cengiz A. Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer [Ｊ]. Hepatogastroenterology,2003; 50(53)∶1669.
23.	Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era? [Ｊ]. JOP,2006; 7(4)： 332.
24.	彭承宏，程東峰，沈柏用，等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點 [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(5)： 506.
25.	孫備, 陳華. 胰腺癌外科治療的現狀與展望 [Ｊ]. 中國普外基礎與臨床雜志,2008; 15(8)： 547.
26.	Fang WL, Shyr YM, Su CH. Long-term follow-up study of surgical treatment for pancreatic stones [Ｊ]. Hepatogastroenterology,2007; 54(73)： 246.
27.	Choi KS, Kim MH. Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones [Ｊ].J Hepatobiliary Pancreat Surg,2006; 13(2)： 86.

1. 1張國偉，周杰，李朝龍,等.胰石癥的診斷與治療體會(附16例報告) [Ｊ]. 中華肝膽外科雜志， 2003； 9 (11)： 648 2李建水，張肇達，唐勇，等. 胰管結石的臨床分析 [Ｊ]. 中國普外基礎與臨床雜志,2006; 13(4)： 456.
2. 10Paulino-Netto A, Dreiling DA, Baronofsky ID. The relationship between pancreatic calcification and cancer of the pancreas [Ｊ]. Ann Surg,1960; 151(4)： 530 11Machiki Y, Nimura Y, Kamiya J,et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones [Ｊ]. Int J Pancreatol,1997; 22(3)： 187.
3. Saraya A, Acharya SK, Vashist S, et al. A pancreatography study of chronic calcific pancreatitis of the tropics [Ｊ]. Trop Gastroenterol,2002; 23(4)： 167.
4. 熊先澤，敬靜，彭其芳. 胰管結石慢性胰腺炎的診治 [Ｊ]. 中國普外基礎與臨床雜志,2007; 14（1）： 94.
5. Patard L,Lallemand JY,Stoven V.An insight into the role of human pancreatic lithostathine [Ｊ]. JOP,2003; 4(2)： 92.
6. Jin CX, Naruse S, Kitagawa M,et al. Pancreatic stone protein of pancreatic calculi in chronic calcified pancreatitis in man [Ｊ]. JOP,2002; 3(2)： 54.
7. Nakamura M, Oka M, Iizuka N, et al. Osteopontin expression in chronic pancreatitis [Ｊ]. Pancreas,2002; 25(2)： 182.
8. Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis [Ｊ]. Digestion,1998; 59 Suppl 4： 49.
9. Nagai H, Ohtsubo K. Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis [Ｊ]. Gastroenterology,1984; 86(2)： 331.
10. 何振平, 鄧有松, 馬寬生, 等. 胰管結石與并發胰腺癌 [Ｊ]. 中華肝膽外科雜志,2002; 8(2)： 90.
11. Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status [Ｊ]. AJR Am J Roentgenol,1995; 165(5)： 1175.
12. Procacci C, Graziani R, Bicego E, et al.Intraductal mucin-producing tumors of the pancreas: imaging findings [Ｊ]. Radiology,1996; 198(1)： 249.
13. Kahl S, Glasbrenner B, Zimmermann S,et al. Endoscopic ultrasound in pancreatic diseases [Ｊ]. Dig Dis,2002; 20(2)： 120〖ＺＫ).
14. Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [Ｊ]. Cancer, 1992; 70(11)： 2610.
15. 劉訓良, 杜競輝, 戴存才，等.胰液細胞學檢查與PCR-SSP診斷胰腺癌之比較 [Ｊ]. 中華肝膽外科雜志, 1999; 5(2)： 106.
16. Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [Ｊ]. Hepatogastroenterology, 1999; 46(25)： 31.
17. 周國雄，黃介飛，張弘，等. 內鏡下胰液收集及腫瘤標記物檢測對胰腺癌的診斷價值 [Ｊ].臨床內科雜志,2005;22(6)： 397.
18. Tada M, Komatsu Y, Kawabe T, et al. Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor [Ｊ]. Am J Gastroenterol,2002; 97(9)： 2263.
19. Liu F, Li ZS, Xu GM, et al. Detection of K-ras gene mutation at codon 12 by pancreatic duct brushing for pancreatic cancer [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(2)： 313.
20. Yu XJ, Long J, Fu DL, et al. Analysis of gene expression profiles in pancreatic carcinoma by using cDNA microarray [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(3)： 467.
21. Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success [Ｊ]. Gastrointest Endosc,2002; 56(4)： 501.
22. Ozkan H, Kaya M, Cengiz A. Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer [Ｊ]. Hepatogastroenterology,2003; 50(53)∶1669.
23. Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era? [Ｊ]. JOP,2006; 7(4)： 332.
24. 彭承宏，程東峰，沈柏用，等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點 [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(5)： 506.
25. 孫備, 陳華. 胰腺癌外科治療的現狀與展望 [Ｊ]. 中國普外基礎與臨床雜志,2008; 15(8)： 547.
26. Fang WL, Shyr YM, Su CH. Long-term follow-up study of surgical treatment for pancreatic stones [Ｊ]. Hepatogastroenterology,2007; 54(73)： 246.
27. Choi KS, Kim MH. Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones [Ｊ].J Hepatobiliary Pancreat Surg,2006; 13(2)： 86.

《中國普外基礎與臨床雜志》

胰管結石合并胰腺癌10例診治回顧分析

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《中國普外基礎與臨床雜志》

胰管結石合并胰腺癌10例診治回顧分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

摘要全文圖表視頻參考文獻施引文獻補充材料