包裹性胰腺壞死被誤診為胰腺囊實性腫瘤的原因分析：附 12 例報道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

岳鵬舉 ^1,2 ,  田伯樂 ¹

1. ;
2. ;

Corresponding?author：

田伯樂, Email: bo-le@medmail.com.cn

Keywords：

包裹性胰腺壞死; 胰腺囊實性腫瘤; 誤診; 原因

DOI：

10.7507/1007-9424.201708025

Video：

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目的探討包裹性胰腺壞死（walled-off pancreatic necrosis，WOPN）誤診為胰腺囊實性腫瘤（pancreatic cystic neoplasm，PCN）的原因。方法回顧性分析 2009–2013 期間華西醫院胰腺外科收治的術前診斷為胰腺 PCN 而術后病理學診斷為 WOPN 的 12 例患者的臨床資料。結果 12 例患者術前診斷為胰腺 PCN，而術后病理學診斷為 WOPN。其中女 2 例，男 10 例；年齡 36～68 歲、（47.1±10.7）歲；病程 0.5～48.0 個月，中位數為 1.0 個月；主要臨床表現：腹痛 12 例，體質量減輕 7 例；術前 1 例總膽紅素水平增高，2 例血淀粉酶水平增高，4 例癌胚抗原（CEA）水平增高，4 例 CA19-9 水平增高，4 例 CA-125 水平增高。8 例行腹部增強 MRI 檢查，7 例行腹部增強 CT 檢查，1 例行正電子發射計算機斷層顯像（PET-CT）檢查，提示 7 例包塊位于胰頭，5 例位于胰尾；腫塊最大徑 1.8～11.0 cm、（4.9±2.9）cm，其中 4 例最大直徑超過 5 cm；3 例腹腔內發現腫大淋巴結；4 例腫塊內部分隔；8 例呈類腫瘤表現。結論 WOPN 與 PCN 的鑒別需要根據臨床、實驗室檢查及影像學特點進行綜合判斷，影像學檢查是主要的鑒別方法，但同時也是誤診的主要原因。此外，男性患者可能更易誤診。

Citation： 岳鵬舉, 田伯樂. 包裹性胰腺壞死被誤診為胰腺囊實性腫瘤的原因分析：附 12 例報道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(1): 83-86. doi: 10.7507/1007-9424.201708025 Copy

1.	Spence RA, Dasari B, Love M, et al. Overview of the investigation and management of cystic neoplasms of the pancreas. Dig Surg, 2011, 28(5-6): 386-397.
2.	Puli SR, Graumlich JF, Pamulaparthy SR, et al. Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol, 2014, 28(1): 50-53.
3.	Stamatakos M, Stefanaki C, Kontzoglou K, et al. Walled-off pancreatic necrosis. World J Gastroenterol, 2010, 16(14): 1707-1712.
4.	Lennon AM, Wolfgang C. Cystic neoplasms of the pancreas. J Gastrointest Surg, 2013, 17(4): 645-653.
5.	Gluck M, Ross A, Irani S, et al. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol, 2010, 8(12): 1083-1088.
6.	Munene G, Dixon E, Sutherland F. Open transgastric debridement and internal drainage of symptomatic non-infected walled-off pancreatic necrosis. HPB (Oxford), 2011, 13(4): 234-239.
7.	Sarr MG. 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn, 2013, 123(3): 118-124.
8.	Gardner TB, Chahal P, Papachristou GI, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc, 2009, 69(6): 1085-1094.
9.	Gardner TB, Coelho-Prabhu N, Gordon SR, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc, 2011, 73(4): 718-726.
10.	Varadarajulu S, Phadnis MA, Christein JD, et al. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc, 2011, 74(1): 74-80.
11.	Takahashi N, Papachristou GI, Schmit GD, et al. CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol, 2008, 18(11): 2522-2529.
12.	Papachristou GI, Takahashi N, Chahal P, et al. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg, 2007, 245(6): 943-951.
13.	Bollen TL, Besselink MG, van Santvoort HC, et al. Toward an update of the atlanta classification on acute pancreatitis: review of new and abandoned terms. Pancreas, 2007, 35(2): 107-113.
14.	Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, et al. Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol, 2011, 20(2): e84-e92.
15.	Procacci C, Carbognin G, Accordini S, et al. CT features of malignant mucinous cystic tumors of the pancreas. Eur Radiol, 2001, 11(9): 1626-1630.
16.	Sperti C, Pasquali C, Chierichetti F, et al. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg, 2001, 234(5): 675-680.
17.	Rasmussen I, S?rensen J, L?ngstr?m B, et al. Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses? Scand J Surg, 2004, 93(3): 191-197.
18.	Canto MI, Hruban RH, Fishman EK, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology, 2012, 142(4): 796-804.

1. Spence RA, Dasari B, Love M, et al. Overview of the investigation and management of cystic neoplasms of the pancreas. Dig Surg, 2011, 28(5-6): 386-397.
2. Puli SR, Graumlich JF, Pamulaparthy SR, et al. Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol, 2014, 28(1): 50-53.
3. Stamatakos M, Stefanaki C, Kontzoglou K, et al. Walled-off pancreatic necrosis. World J Gastroenterol, 2010, 16(14): 1707-1712.
4. Lennon AM, Wolfgang C. Cystic neoplasms of the pancreas. J Gastrointest Surg, 2013, 17(4): 645-653.
5. Gluck M, Ross A, Irani S, et al. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol, 2010, 8(12): 1083-1088.
6. Munene G, Dixon E, Sutherland F. Open transgastric debridement and internal drainage of symptomatic non-infected walled-off pancreatic necrosis. HPB (Oxford), 2011, 13(4): 234-239.
7. Sarr MG. 2012 revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn, 2013, 123(3): 118-124.
8. Gardner TB, Chahal P, Papachristou GI, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc, 2009, 69(6): 1085-1094.
9. Gardner TB, Coelho-Prabhu N, Gordon SR, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc, 2011, 73(4): 718-726.
10. Varadarajulu S, Phadnis MA, Christein JD, et al. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc, 2011, 74(1): 74-80.
11. Takahashi N, Papachristou GI, Schmit GD, et al. CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol, 2008, 18(11): 2522-2529.
12. Papachristou GI, Takahashi N, Chahal P, et al. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg, 2007, 245(6): 943-951.
13. Bollen TL, Besselink MG, van Santvoort HC, et al. Toward an update of the atlanta classification on acute pancreatitis: review of new and abandoned terms. Pancreas, 2007, 35(2): 107-113.
14. Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, et al. Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol, 2011, 20(2): e84-e92.
15. Procacci C, Carbognin G, Accordini S, et al. CT features of malignant mucinous cystic tumors of the pancreas. Eur Radiol, 2001, 11(9): 1626-1630.
16. Sperti C, Pasquali C, Chierichetti F, et al. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg, 2001, 234(5): 675-680.
17. Rasmussen I, S?rensen J, L?ngstr?m B, et al. Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses? Scand J Surg, 2004, 93(3): 191-197.
18. Canto MI, Hruban RH, Fishman EK, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology, 2012, 142(4): 796-804.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

包裹性胰腺壞死被誤診為胰腺囊實性腫瘤的原因分析：附 12 例報道

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