肿块型胰腺炎与胰腺癌的超声检查鉴别诊断与分析
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摘要
目的探讨肿块型胰腺炎(IPM)与胰腺癌(PC)的超声检查鉴别诊断价值,为临床治疗提供依据。方法依据纳入排除标准,从2010年1月～2016年6月收治的肿块型胰腺炎患者中和胰腺癌患者中各随机抽取60例作为观察对象,所有患者均经过手术病理证实。对所有患者进行超声检查。比较两组声像图的差异。结果 IPM组中,一共有61个胰腺肿块。PC组中,一共有60个胰腺肿块。肿块型胰腺炎与胰腺癌超声诊断符合率分别为29.51%(18/61)和86.67%(52/60)。漏诊分别13.11%(8/61)和6.67%(4/60)。误诊分别57.38%(35/61)和6.67%(4/60)。IPM组中,超声检查发现53个病灶,其中,低回声36例,胰腺肿块内钙化13例,肿块后方回声增强23例,扩张的胰管贯穿肿块19例,胰管内结石11例,假性囊肿9例。PC组中,超声检查发现56个病灶,其中,低回声52例,胰腺肿块内钙化2例,肿块后方回声增强0例,扩张的胰管贯穿肿块0例,胰管内结石0例,假性囊肿0例。差异均有统计学意义(P<0.01)。结论正确认识IPM和PC的各种超声征象,对这两种病变的诊断具有重要意义。
Objective To investigate the differential diagnosic value of inflammatory pancreatic masses(IPM) and pancreatic cancers(PC) by ultrasonography and to provide evidence for clinical treatment strategy. Methods According to inclusion and exclusion criteria, 60 patients with IPM and 60 patients with PC who were admitted and treated from January 2010 to June 2016 were enrolled in the study. All the patients were identified by surgical pathological examination. The ultrasound was performed for all the patients. The differences of sonographic features were observed and compared between the two groups. Results In group IPM, there were 61 pancreatic masses. In group PC, there were 60 pancreatic masses.The diagnostic rate of ultrasound was 29.51%(18/61) in IPM group and 86.67%(52/60) in PC group. The rate of missed diagnosis was 13.11%(8/61) in IPM group and 6.67%(4/60) in PC group. The rate of misdiagnosis was 57.38%(35/61) in IPM group and 6.67%(4/60) in PC group. In group IPM, 53 cases were detected by ultrasound. Among them, 36 cases were low echo, 13 cases had pancreatic mass calcification, 23 cases had posterior echo enhancement, 19 cases had the dilated pancreatic duct through the masses, 11 cases had pancreatic duct stones, 9 cases had pseudocysts. In group PC, 56 cases were detected by ultrasound. Among them, 52 cases were low echo, 2 cases had pancreatic mass calcification. 0 case had posterior echo enhancement, 0 case had the dilated pancreatic duct through the masses, 0 case had pancreatic duct stones, 0 case had pseudocysts. There was statistical difference for these ultrasound findings between two groups(P<0.01). Conclusion Accurate evaluation of various ultrasound signs in IPM and PC is of great importance in the diagnosis of the two diseases.
Objective To investigate the differential diagnosic value of inflammatory pancreatic masses(IPM) and pancreatic cancers(PC) by ultrasonography and to provide evidence for clinical treatment strategy. Methods According to inclusion and exclusion criteria, 60 patients with IPM and 60 patients with PC who were admitted and treated from January 2010 to June 2016 were enrolled in the study. All the patients were identified by surgical pathological examination. The ultrasound was performed for all the patients. The differences of sonographic features were observed and compared between the two groups. Results In group IPM, there were 61 pancreatic masses. In group PC, there were 60 pancreatic masses.The diagnostic rate of ultrasound was 29.51%(18/61) in IPM group and 86.67%(52/60) in PC group. The rate of missed diagnosis was 13.11%(8/61) in IPM group and 6.67%(4/60) in PC group. The rate of misdiagnosis was 57.38%(35/61) in IPM group and 6.67%(4/60) in PC group. In group IPM, 53 cases were detected by ultrasound. Among them, 36 cases were low echo, 13 cases had pancreatic mass calcification, 23 cases had posterior echo enhancement, 19 cases had the dilated pancreatic duct through the masses, 11 cases had pancreatic duct stones, 9 cases had pseudocysts. In group PC, 56 cases were detected by ultrasound. Among them, 52 cases were low echo, 2 cases had pancreatic mass calcification. 0 case had posterior echo enhancement, 0 case had the dilated pancreatic duct through the masses, 0 case had pancreatic duct stones, 0 case had pseudocysts. There was statistical difference for these ultrasound findings between two groups(P<0.01). Conclusion Accurate evaluation of various ultrasound signs in IPM and PC is of great importance in the diagnosis of the two diseases.
引文
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[10] 丁建辉,曾蒙苏,周康荣,等.胰腺癌和慢性胰腺炎胆胰管扩张的CT分析[J].临床放射学杂志,2002,21(7):539-542.
[11] 孙雷.彩色多普勒超声对肿块型胰腺炎和胰腺癌的诊断价值[J].河北医药,2016,38(12):1816-1818.
[2] Nair RJ,Lawler L,Miller MR.Chronic pancreatitis [J].Am Fam Physician,2007,76(11):1679-1688.
[3] 周军,荣阳,倪博,等.彩超对胰腺癌与肿块型胰腺炎的诊断价值[J].中国临床医生,2014,42(1):57-58.
[4] 吴乃森.腹部超声诊断与鉴别诊断学[M].第2版.北京:科学技术文献出版社,2001.159.
[5] 史敏,张晶,陈颖,等.慢性纤维包块型胰腺炎与胰腺导管腺癌癌旁组织的病理学及免疫组化特征[J].中华胰腺病杂志,2013,13(5):324-329.
[6] 李光纪,陈首名,罗鹰,等.增强CT及DWI序列对胰腺炎及胰腺癌的诊断分析[J].医学影像学杂志,2017,27(6):1115-1118.
[7] 郑建明,朱明华.胰腺肿瘤组织学新的分类法[J].胰腺病学,2003,3(1):49-51.
[8] 周康荣.螺旋CT[M].上海:上海医科大学出版社,1998.164-175.
[9] 徐俊,陆建平,王剑,等.胰胆管扩张的MRCP表现对胰腺癌和慢性胰腺炎的诊断意义[J].胰腺病学,2004,4(1):19-22.
[10] 丁建辉,曾蒙苏,周康荣,等.胰腺癌和慢性胰腺炎胆胰管扩张的CT分析[J].临床放射学杂志,2002,21(7):539-542.
[11] 孙雷.彩色多普勒超声对肿块型胰腺炎和胰腺癌的诊断价值[J].河北医药,2016,38(12):1816-1818.