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目的探讨早期胰腺癌的临床表现与诊断方法,提高胰腺癌的早期诊断率。方法对资料完备的64例胰腺癌患者的临床资料进行回顾性分析。结果首发症状腹泻者24例,初次B超检查均发现肝内外胆管轻度或中度扩张,其中3例合并胰管扩张;首发症状黄疸者22例,初次B超检查发现胰头部呈局限性肿大,主胰管重度扩张,肝内外胆管及胆总管中度或重度扩张。首发症状腰背疼痛18例,初次B超检查发现胰体尾边缘部有高回声光团,主胰管、胆总管不扩张。B超、CT、磁共振胰胆管造影(MRCP)及内镜逆行胰胆管造影(ERCP)为重要的辅助检查。手术、B超或CT引导下穿刺活检是最直接诊断的依据。血清癌胚抗原(CEA)和糖类抗原19-9(CA19-9)联合检测是确诊的最佳手段。结论重视胰腺癌的早期非特异性症状,警惕肝内外胆管轻度或中度扩张可能为早期胰腺癌,对高危可疑患者应联合应用影像学、肿瘤标志物、穿刺、剖腹探查等方法提高诊断率。
Objective To investigate the clinical manifestations and diagnosis of early pancreatic cancer and to improve the early diagnosis rate of pancreatic cancer. Methods The clinical data of 64 patients with complete pancreatic cancer were retrospectively analyzed. Results The first symptom of diarrhea in 24 cases, the first B-ultrasound were found in the intrahepatic and extrahepatic bile duct mild or moderate expansion, of which 3 cases with pancreatic duct dilatation; first symptom jaundice in 22 cases, the first B-scan revealed limited pancreatic head Swollen, severe expansion of the main pancreatic duct, intrahepatic bile duct and common or moderate dilatation of the common bile duct. The first symptom of back pain in 18 cases, the first B-ultrasound found that the edge of the body of pancreas tail echo hyperechoic group, the main pancreatic duct, common bile duct does not dilate. B-ultrasound, CT, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are important auxiliary examinations. Surgical, B-or CT-guided biopsy is the most direct basis for diagnosis. The combination of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) is the best method of diagnosis. Conclusion Attention should be paid to the early nonspecific symptoms of pancreatic cancer. Be alert to mild or moderate intrahepatic or extrahepatic bile duct enlargement may be early pancreatic cancer. To improve the diagnosis rate of high risk suspicious patients combined with imaging, tumor markers, puncture and laparotomy.