• 西安交通大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院肝膽外科(西安 710061);

目的 探討胰管結(jié)石與胰腺癌的關(guān)系以及胰管結(jié)石伴發(fā)胰腺癌的臨床特點(diǎn)、診斷及治療。
方法 回顧性總結(jié)分析1992年3月至2007年9月期間我院收治的10例胰管結(jié)石合并胰腺癌患者的臨床資料。
結(jié)果 本組病例多以上腹部疼痛為首發(fā)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(shù)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(shù)，1例行活檢術(shù)，1例由于漏診行胰管切開取石、胰管空腸吻合術(shù)。
結(jié)論 多種診斷方法聯(lián)合應(yīng)用可提高胰管結(jié)石合并胰腺癌診斷的準(zhǔn)確率，但目前該病的術(shù)前診斷陽性率不高，應(yīng)常規(guī)行術(shù)中病理學(xué)檢查； 其首選術(shù)式為胰十二指腸切除術(shù)。

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

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1. 1張國(guó)偉， 周杰， 李朝龍,等.胰石癥的診斷與治療體會(huì)(附16例報(bào)告) [Ｊ]. 中華肝膽外科雜志， 2003； 9 (11)： 648 2李建水， 張肇達(dá)， 唐勇， 等. 胰管結(jié)石的臨床分析 [Ｊ]. 中國(guó)普外基礎(chǔ)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(jié)石慢性胰腺炎的診治 [Ｊ]. 中國(guó)普外基礎(chǔ)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(jié)石與并發(fā)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(xùn)良, 杜競(jìng)輝, 戴存才， 等.胰液細(xì)胞學(xué)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(guó)雄， 黃介飛， 張弘， 等. 內(nèi)鏡下胰液收集及腫瘤標(biāo)記物檢測(cè)對(duì)胰腺癌的診斷價(jià)值 [Ｊ].臨床內(nèi)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?hào)|峰， 沈柏用， 等. 胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評(píng)估和操作要點(diǎn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(5)： 506.
25. 孫備, 陳華. 胰腺癌外科治療的現(xiàn)狀與展望 [Ｊ]. 中國(guó)普外基礎(chǔ)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. 1張國(guó)偉， 周杰， 李朝龍,等.胰石癥的診斷與治療體會(huì)(附16例報(bào)告) [Ｊ]. 中華肝膽外科雜志， 2003； 9 (11)： 648 2李建水， 張肇達(dá)， 唐勇， 等. 胰管結(jié)石的臨床分析 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志,2006; 13(4)： 456.
  2. 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. 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. 4. 熊先澤， 敬靜， 彭其芳. 胰管結(jié)石慢性胰腺炎的診治 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志,2007; 14（1）： 94.
  5. 5. Patard L,Lallemand JY,Stoven V.An insight into the role of human pancreatic lithostathine [Ｊ]. JOP,2003; 4(2)： 92.
  6. 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. 7. Nakamura M, Oka M, Iizuka N, et al. Osteopontin expression in chronic pancreatitis [Ｊ]. Pancreas,2002; 25(2)： 182.
  8. 8. Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis [Ｊ]. Digestion,1998; 59 Suppl 4： 49.
  9. 9. Nagai H, Ohtsubo K. Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis [Ｊ]. Gastroenterology,1984; 86(2)： 331.
  10. 10. 何振平, 鄧有松, 馬寬生, 等. 胰管結(jié)石與并發(fā)胰腺癌 [Ｊ]. 中華肝膽外科雜志,2002; 8(2)： 90.
  11. 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. 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. 13. Kahl S, Glasbrenner B, Zimmermann S,et al. Endoscopic ultrasound in pancreatic diseases [Ｊ]. Dig Dis,2002; 20(2)： 120〖ＺＫ).
  14. 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. 15. 劉訓(xùn)良, 杜競(jìng)輝, 戴存才， 等.胰液細(xì)胞學(xué)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. 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. 17. 周國(guó)雄， 黃介飛， 張弘， 等. 內(nèi)鏡下胰液收集及腫瘤標(biāo)記物檢測(cè)對(duì)胰腺癌的診斷價(jià)值 [Ｊ].臨床內(nèi)科雜志,2005;22(6)： 397.
  18. 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. 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. 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. 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. 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. 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. 24. 彭承宏， 程?hào)|峰， 沈柏用， 等. 胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評(píng)估和操作要點(diǎn) [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2006; 13(5)： 506.
  25. 25. 孫備, 陳華. 胰腺癌外科治療的現(xiàn)狀與展望 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志,2008; 15(8)： 547.
  26. 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. 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.