RESUMO
Objective To study the clinical features,experience of diagnosis and treatment in the IgG4 related pancreatitis and cholangitis.Methods Clinical date of sixteen cases of IgG4 related pancreatitis and cholangitis were analyzed as the observation group collecting from March 2006 to August 2016 of General Hospital of the Chinese People's Liberation Army.The clinical symptoms,imaging features and pathological findings were studied.Ten cases of bile duct carcinoma or pancreatic cancer with normal IgG4 value and no related immunodeficiency disease were selected as control group during the same period.Serum IgG4 values of two groups were observed.The patients were followed up in outpatient department after their discharged.The serum bilirubin,liver enzymes,serum IgG4,CA19-9 and CEA antibodies were checked up every 6 months,including imaging studies.The longest follow-up period was 6 years.Measurement data with normal distribution was represented as (x ± s) and comparison between the two groups was analyzed using t test.The count data were described as n (％).Results In observation group,cases with jaundice accounted for 68.75％ (11/16),abdominal pain and distension,loss of appetite and weight loss accounted for 43.75％ (7/16),62.50％ (10/16) and 37.50％ (6/16),respectively.Comparing different imaging methods,there were advantage in displaying the morphological signs of bile duct and pancreatic duct by MRCP.MRI was superior to the other methods in demonstrating pancreatic swelling and peripheral edema.Serum IgG4 value was an important basis for the diagnosis of the disease,the average value of serum IgG4 in the observation group was (105.7 ±21.6) g/L in 12 cases.The mean serum IgG4 level of 10 cases of control group (bile duct cancer and pancreatic cancer) was (9.1 ± 0.05) g/L,There was significant difference between the two groups (P =0.004).The pathological features of IgG4 associated cholangitis were massive lymphocytes,plasma cell infiltration,bile duct fibrosis,occlusive phlebitis,and IgG4 positive plasma cell infiltration.The observation group was followed up for 16 cases,12 cases survival,4 cases lost,the longest follow-up period was 6 years.Except for 3 patients who suffered jaundice again during hormone therapy,all the clinical symptoms of the remaining patients disappeared,all the indexes were normal.Conclusions The diagnosis of IgG4 related pancreatitis and cholangitis should be carefully diagnosed,serum IgG4 examination is an important criterion.The image data are an important means to confirm the diagnosis.Surgical intervention should be performed in failure of the hormone treatment.
RESUMO
Objective To summarize the results of a new pancreaticojejunostomy technique designed to decrease incidence of pancreatic leakage in pancreatoduodenectomy.Methods The clinical data of 11 cases of pancreatoduodenectomy using remnant pancreatico-jejunum end-to-end anastomosis with external drainage of full pancreatic juice was analyzed retrospectively.Briefly,5-0 bioabsorbable suture was penetrated through the pancreatic stump and stent and then circulated the pancreatic stump for 2 circles and ligated.Octreotide was not administered in any cases post-operation.Results The operation was simple and timespared.Neither pancreatic leakage nor postoperative bleeding occurred in the cases.From 4 months to 3 years following operation,no other complications were found in all cases.Conclusions The method was safe,feasible and effective to decrease incidence of pancreatic leakage in pancreatoduodenectomy.