單純型溝糟狀胰臟炎

Pure-Form Groove Pancreatitis

陳瑞灝(Jui-Hao Chen) ； 吳金珠(Chin-Chu Wu)

《台灣醫學》 23卷1期 (2019/01) Pp. 31-37

https://doi.org/10.6320/FJM.201901_23(1).0004

摘要

溝糟狀胰臟炎（groove pancreatitis）是一種不常見的慢性胰臟炎，發炎組織位於胰臟頭、十二指腸及總膽管所圍起的溝槽區域。溝槽狀胰臟炎分為兩種不同的類型：單純型（pure form）及節段型（segmental form），前者的纖維化病變主要在溝糟區及十二指腸壁，而後者除了前述之病變，還波及胰臟頭。大部分病人為中年酗酒抽菸的男性，致病機轉不清楚，主要症狀為腹痛，噁吐及體重減輕，黃疸不常見。十二指腸旁囊腫出現於很多病人，一般咸信它是胰臟異位組織的囊性營養（cystic dystrophy of a heterotopic pancreas）。核磁共振暨膽胰道攝影是目前最受肯定的檢查，實驗室生化檢查對診斷的幫助較少，血清澱粉酶、脂肪酶及肝功能可能輕微上升，也可能正常。腫瘤標記很少上升。這裡報告一位中年男性（45歲）。酗酒抽菸30年，自述上腹痛4個月。生化檢查及腹部超音波檢查完全正常，電腦斷層掃描及核磁共振暨膽胰道攝影兩者均可清晰看到位於十二指腸及胰臟頭之間的板狀組織以及十二指腸旁的囊腫。內視鏡逆行性膽胰管攝影及核磁共振膽胰道攝影發現膽管及胰管均正常。

關鍵字

溝糟狀胰臟炎 ； 十二指腸旁囊腫 ； 胰臟異位組織的營養性退化

並列摘要

Groove pancreatitis (GP) is an uncommon form of chronic pancreatitis. It is classified into two forms of groove pancreatitis, the ＂segmental＂ and the ＂pure＂. The former involves the pancreatic head with development of scar tissue within the groove, while the latter affects only the groove itself, sparing the pancreatic head. Most patients are middle-aged men, typically with history of heavy alcohol drinking and/or tabacco smoking. The pathogenesis is unclear. Most patients present with severe abdominal pain, recurrent vomiting and weight loss. Jaundice is relatively rare. Paraduodenal cyst is very common in GP and it is present within the duodenal wall or in the groove area. It originates from cystic dystrophy of ectopic pancreatic tissue. CT and MRI/MRCP are useful in the diagnosis of GP. Blood biochemistry tests often reveal mildly elevated or normal pancreatic enzymes and tumor markers are usually normal. We presented a case of 45 year-old alcoholic male patient. He complained of upper abdominal pain for four months. Serum biochemistry examination revealed normal serum amylase level, serum lipase level and normal liver function. The CEA and CA19-9 were also within normal limit. Abdominal ultrasound revealed unremarkable change. CT and MRI/MRCP reveled typical changes of GP. Needle aspiration of duodenal submucosal cyst revealed marked elevation of lipase and amylase (Lipase 107200 U, Amylase 31980 U). The bile duct and pancreatic duct were normal in MRCP and ERCP.

並列關鍵字

groove pancreatitis ； paraduodenal cyst ； cystic dystrophy of ectopic pancreas

參考文獻

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