Chronic Calcifying Pancreatitis: A Clinical Study of 22 Patients

慢性鈣化性胰臟炎：22例之臨床研究

林肇堂(Jaw-Town Lin) ； 王德宏(Teh-Hong Wang) ； 陳定信(Ding-Shinn Chen) ； 莊立民(Lee-Ming Chuang) ； 魏達成(Ta-Cheng Wei)

《中華民國消化系醫學會雜誌》 4卷3期 (1987/09) Pp. 93-104

https://doi.org/10.6557/GJTa.198709_4(3).0001

摘要

吾人囘顧22例慢性鈣化性胰臟炎之臨床資料以探討此項疾病之致病原因，臨床表現，診斷方法，併發疾病，治療方式與預後。其中男性15例，女性7例，平均年齡47.3歲，致病原因以長期酗酒(45.4%)最高，其次為原因不明(36.4%)，膽道疾病僅佔2例(9.1%)。其臨床表徵以腹痛(72.7%)最多，其次為體重減輕(45.5%)及慢性下痢(36.4%)，但有2例(9.1%)為完全無症狀。大部份病人(77.3%)之理學檢查並無異樣，但血糖檢查發現顯著糖尿病者11例(50%)，葡萄糖耐量試驗異常者3例(13.6%)。血清轉氨酶，鹼性磷酸酶，伽瑪麩胺醯醞轉移酶，膽色素及澱粉酶之異常昇高比例分別為45.5%，22.7%，22.7%，18.2%及22.7%。糞便中發現有脂肪球微粒者共6例。大多數鈣化位置散佈全胰臟之病人，其鈣化點較小，且為多發。反之鈣化位置局限一處之病人，鈣化點較大，且多為單獨一個。以紅外線檢視所有切除之鈣化病灶之成分均為碳酸鈣。對於胰臟實質與併發症之病變，電腦斷層掃描與超音波掃描具有相似之診斷能力，但經內視鏡逆行性膽胰管造影術對於胰管之變化最具診斷力。電腦斷屬掃描則對於鈣化點之敏感性最高。13位病人接受內科治療，其餘9位病人接受外科治療，其預後差別甚大。兩位原本無病狀之病人仍然不變，9位病人則在內科或外科治療後症狀獲得改善或緩解，另外9位接受內科或外科治療之病人仍然持續腹痛及慢性下痢，其餘2位合併癌症之病人均在6個月內因癌症擴散而死亡。此症雖因胰臟鈣化之特徵而易於診斷，但不論內科或外科療法對症狀之改善有限。

關鍵字

慢性胰臟炎 ； 胰臟鈣化 ； 慢性鈣化性胰鈣炎 ； 電腦斷層掃描術

並列摘要

The medical records of 22 patients with chronic calcifying pancreatitis (CCP) were retrospectively studied to investigate the etiology, clinical presentation, diagnosis, associated disorders, treatment, and outcome. There were 15 men and 7 women with a mean age of 47.3 years. Although 10 (45.5%) of the patients were caused by chronic alcoholism, 8 (36.4%) of them had no obvious etiology, 2 (9.1%) patients was caused by hereditary factor, and only 2 (9.1%) patients were associated with biliary diseases. Abdominal pain, body weight loss, and chronic diarrhea occurred in 72.7%, 45.5%, and 36.4% of the patients, respectively, while 2 subjects (9.1%) were asymptomatic. Most patients (77.3%) gave a negative result on physical examination. 11 (50%) patients had overt diabetes, and 3 (13.6%) had glucose intolerance. The frequency of elevated serum levels of transaminase, alkaline phosphatase, gamma-glutarmyl trans-peptidase, bilirubin, and amylase was 45.5%, 22.7%, 22.7%, 18.2%, and 22.7%, respectively. Fecal fat droplets were detected in 6 patients. Nine patients with diffuse calcifications had small and multiple concretions while 13 patients with localized calcifications had single and large pancreatic stones. All the surgically removed calcifications were mainly composed of calcium carbonate by infrared spectrophotometry. Ultrasonography and computed tomography (CT) similarly demonstrated pathologic changes in the pancreatic parenchyma while endoscopic retrograde pancreatography provided best information concerning the ductal changes. CT was the best in detecting the calcifications. Medical treatment was given in 13 patients (59.1%) while the remaining 9 patients (40.9%) received surgery. Their prognosis varied widely. The two asymptomatic subjects remained stationary on follow-up. Nine patients had persistent pain and steatorrhea despite medical and/or surgical treatment, whereas the other 9 had symptomatic improvement. Two patients with coexisted carcinoma died within 6 months. We conclude that CCP is easy to diagnose because of the presence of pancreatic calcifications. Symptomatic improvement, however, is sometimes difficult by medical or surgical treatment.

並列關鍵字

chronic pancreatitis ； pancreatic calcification ； chronic calcifying pancreatitis ； computed iomography