1 例 IgG4 相关性硬化性胆管炎误诊为胆管癌的病例分析并文献复习_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

孙丹 ¹ , 耿冲 ¹ , 武永康 ² , 李立新 ² , 张元 ³ ,  王春晖 ¹

1. ;
2. ;
3. ;

Corresponding author：

王春晖, Email: wangch@scu.edu.cn

Keywords：

IgG4 相关性疾病; IgG4 相关性硬化性胆管炎; 胆管癌

DOI：

10.7507/1007-9424.201610030

Video：

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目的探讨 IgG4 相关性硬化性胆管炎的临床表现、诊断、鉴别诊断及治疗。方法对 2014 年在四川大学华西医院就诊的 1 例误诊为胆管癌的 IgG4 相关性硬化性胆管炎患者的临床资料进行回顾性分析，包括既往误诊为胆管癌的病史、实验室及辅助检查等，结合相关文献分析误诊的原因并总结经验，以指导日后的临床工作。结果该病例术前高度怀疑为肿瘤，行手术治疗后病理报告未查见确切癌细胞，后因黄疸多次安置、更换胆管支架，最终诊断为 IgG4 相关性硬化性胆管炎，予以激素治疗后好转。结论 IgG4 相关性硬化性胆管炎是较为少见的胆管系统疾病，其诊断较困难，与胆管癌的鉴别十分重要。

Citation： 孙丹, 耿冲, 武永康, 李立新, 张元, 王春晖. 1 例 IgG4 相关性硬化性胆管炎误诊为胆管癌的病例分析并文献复习. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 626-628. doi: 10.7507/1007-9424.201610030 Copy

1.	Smit WL, Culver EL, Chapman RW. New thoughts on immunoglobulin G4-related sclerosing cholangitis. Clin Liver Dis, 2016, 20(1): 47-65.
2.	Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol, 2012, 25(9): 1181-1192.
3.	Okazaki K, Uchida K, Koyabu M, et al. IgG4 cholangiopathy: current concept, diagnosis, and pathogenesis. J Hepatol, 2014, 61(3): 690-695.
4.	Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology, 2008, 134(3): 706-715.
5.	Ohara H, Okazaki K, Tsubouchi H, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci, 2012, 19(5): 536-542.
6.	Nakazawa T, Naitoh I, Hayashi K, et al. Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification. J Gastroenterol, 2012, 47(1): 79-87.
7.	Maeda M, Shimada K. A case of IgG4-related sclerosing cholangitis mimicking an intrahepatic cholangiocellular carcinoma. Jpn J Clin Oncol, 2012, 42(2): 153.
8.	张温温, 范永刚. IgG4 相关性硬化性胆管炎 1 例报告. 临床肝胆病杂志, 2015, 31(9): 1492-1493.
9.	Miki A, Sakuma Y, Ohzawa H, et al. Immunoglobulin G4-related sclerosing cholangitis mimicking hilar cholangiocarcinoma diagnosed with following bile duct resection: report of a case. Int Surg, 2015, 100(3): 480-485.
10.	Joshi D, Webster GJ. Biliary and hepatic involvement in IgG4-related disease. Aliment Pharmacol Ther, 2014, 40(11-12): 1251-1261.
11.	Nakazawa T, Ohara H, Sano H, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc, 2004, 60(6): 937-944.
12.	Iwasaki S, Kamisawa T, Koizumi S, et al. Assessment in steroid trial for IgG4-related sclerosing cholangitis. Adv Med Sci, 2015, 60(2): 211-215.
13.	Sandanayake NS, Church NI, Chapman MH, et al. Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol, 2009, 7(10): 1089-1096.

1. Smit WL, Culver EL, Chapman RW. New thoughts on immunoglobulin G4-related sclerosing cholangitis. Clin Liver Dis, 2016, 20(1): 47-65.
2. Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol, 2012, 25(9): 1181-1192.
3. Okazaki K, Uchida K, Koyabu M, et al. IgG4 cholangiopathy: current concept, diagnosis, and pathogenesis. J Hepatol, 2014, 61(3): 690-695.
4. Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology, 2008, 134(3): 706-715.
5. Ohara H, Okazaki K, Tsubouchi H, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci, 2012, 19(5): 536-542.
6. Nakazawa T, Naitoh I, Hayashi K, et al. Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification. J Gastroenterol, 2012, 47(1): 79-87.
7. Maeda M, Shimada K. A case of IgG4-related sclerosing cholangitis mimicking an intrahepatic cholangiocellular carcinoma. Jpn J Clin Oncol, 2012, 42(2): 153.
8. 张温温, 范永刚. IgG4 相关性硬化性胆管炎 1 例报告. 临床肝胆病杂志, 2015, 31(9): 1492-1493.
9. Miki A, Sakuma Y, Ohzawa H, et al. Immunoglobulin G4-related sclerosing cholangitis mimicking hilar cholangiocarcinoma diagnosed with following bile duct resection: report of a case. Int Surg, 2015, 100(3): 480-485.
10. Joshi D, Webster GJ. Biliary and hepatic involvement in IgG4-related disease. Aliment Pharmacol Ther, 2014, 40(11-12): 1251-1261.
11. Nakazawa T, Ohara H, Sano H, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc, 2004, 60(6): 937-944.
12. Iwasaki S, Kamisawa T, Koizumi S, et al. Assessment in steroid trial for IgG4-related sclerosing cholangitis. Adv Med Sci, 2015, 60(2): 211-215.
13. Sandanayake NS, Church NI, Chapman MH, et al. Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol, 2009, 7(10): 1089-1096.

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1 例 IgG4 相关性硬化性胆管炎误诊为胆管癌的病例分析并文献复习

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