胰腺肿块性炎性病变的临床病理特征

Clinicopathological features of chronic inflammatory mass lesion of the pancreas

摘要:

目的:探讨胰腺肿块性炎性病变的临床病理特征。
方法:回顾性分析肿块性慢性胰腺炎37例的临床资料。符合慢性胰腺炎临床诊断标准者为A组,共17例。行Whipple或胰体部分切除5例,各类内引流术12例。缺乏A组特点、曾拟诊为胰腺癌者为B组,共20例。行Whipple手术4例,胆肠内引流术16例。结果:A组除见胰腺局部质硬的肿块外,全部胰腺质硬者占88.2%;病理见胰腺纤维化瘢痕及少量炎细胞浸润,并有腺泡萎缩、减少,有残余胰岛及导管扩张或局灶钙盐沉积。B组中95.0%仅见胰腺局部质硬肿块,病理见胰腺纤维组织增生伴有不同程度的慢性炎细胞浸润。33例随访1~12年,均未发现胰腺癌变。
结论:胰腺局灶性慢性炎症病变具有假瘤性胰腺炎的特点,行胆管空肠吻合术是有效的治疗方法。

Abstract:

Abstract:Objective:To study the clinicopathological features of chronic inflammatory mass lesion of the pancreas.
Methods : The clinical data of 37 patients with focal chronic inflammatory mass lesion of the pancreas were retrospectively studied. Seventeen cases congruent with the standard clinical diagnostic of chronic pancreatitis were separated into group A; and Whipple procedure was carried out in two cases, resection of the body and tail of the pancreas in 2 cases, local resection in one case, and choledochojejunostomy in 12 cases. Those without the stander clnical features of Group A but with the features of pancreatic tumor were separated into Group B; and Whipple procedure was carried out in 4 cases, choledochojejunostomy in 16 cases.
Results: In group A, except for the local mass lesion, sclerosis of the whole pancreas was found in 88.2% of cases. Pathological examination showed proliferation of fibrous tissue with associated inflammation, as well as acinar atrophy, remnant islet cells, and ductular dilatation and focal calcification. While in Group B, only a local mass lesion of the pancreas was found in 19 cases. The pathological features were characterized histologically by proliferation of fibrous tissue with associated moderate or marked inflammation. No pancreatic carcinoma was found during 1 to 12 years follow-up of 33 cases.
Conclusions:Chronic inflammatory mass lesion of the pancreas showed the clinicopathological features of pseudotumoral pancreatitis. Internal drainage by choledochojejunostomy is suggested as its effective management.