包裹性胰腺坏死被误诊为胰腺囊实性肿瘤的原因分析：附 12 例报道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

岳鹏举 ^1,2 ,  田伯乐 ¹

1. ;
2. ;

Corresponding author：

田伯乐, Email: bo-le@medmail.com.cn

Keywords：

包裹性胰腺坏死; 胰腺囊实性肿瘤; 误诊; 原因

DOI：

10.7507/1007-9424.201708025

Video：

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目的探讨包裹性胰腺坏死（walled-off pancreatic necrosis，WOPN）误诊为胰腺囊实性肿瘤（pancreatic cystic neoplasm，PCN）的原因。方法回顾性分析 2009–2013 期间华西医院胰腺外科收治的术前诊断为胰腺 PCN 而术后病理学诊断为 WOPN 的 12 例患者的临床资料。结果 12 例患者术前诊断为胰腺 PCN，而术后病理学诊断为 WOPN。其中女 2 例，男 10 例；年龄 36～68 岁、（47.1±10.7）岁；病程 0.5～48.0 个月，中位数为 1.0 个月；主要临床表现：腹痛 12 例，体质量减轻 7 例；术前 1 例总胆红素水平增高，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 例行腹部增强 MRI 检查，7 例行腹部增强 CT 检查，1 例行正电子发射计算机断层显像（PET-CT）检查，提示 7 例包块位于胰头，5 例位于胰尾；肿块最大径 1.8～11.0 cm、（4.9±2.9）cm，其中 4 例最大直径超过 5 cm；3 例腹腔内发现肿大淋巴结；4 例肿块内部分隔；8 例呈类肿瘤表现。结论 WOPN 与 PCN 的鉴别需要根据临床、实验室检查及影像学特点进行综合判断，影像学检查是主要的鉴别方法，但同时也是误诊的主要原因。此外，男性患者可能更易误诊。

Citation： 岳鹏举, 田伯乐. 包裹性胰腺坏死被误诊为胰腺囊实性肿瘤的原因分析：附 12 例报道. 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, Sörensen J, Långström 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, Sörensen J, Långström 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

包裹性胰腺坏死被误诊为胰腺囊实性肿瘤的原因分析：附 12 例报道

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