Retrospective Analysis of Diagnosis and Treatment of 10 Cases of Pancreatic Duct Stone Complicated with Pancreatic Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Wei , ZHENG Xin , LIU Qingguang , YAO Yingmin , YU Liang

Department of Hepatobiliary Surgery, The First Affiliated Hospitalof Medical College of Xi’an Jiaotong University,Xi’an 710061, ChinaCorresponding Author:YANG Wei， E-mail：yang_wei@21cn.com;

Corresponding author：

Keywords：

Pancreas; Stone; Tumor

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Objective To investigate the relationship between pancreatic cancer and pancreatic duct stone and the clinical features, diagnosis, treatment of pancreatic duct stone with pancreatic cancer. MethodsThe clinical data of 10 patients suffering pancreatic duct stone with pancreatic cancer, admitted to our hospital from March 1992 to September 2007， were retrospectively analyzed. ResultsThe major symptom was abdominal pain (8/10) in pancreatolithiasis with pancreatic cancer and there were few characteristic symptoms. The positive percentages ofdiagnosis of this disease with B ultrasonography, CT and ERCP wererespectively 4/10, 6/10 and 5/5. The percentage of preoperative final diagnosis was 7/10, meanwhile there were 2 patients who were diagnosed during the operation and 1 patient with missed diagnosis. Surgical treatment was received by all of the patients. Pancreatoduodenectomy was performed in 8 patients. Pancreolithotomy plus pancreaticojejunostomy were performed in 1 patient because of misdiagnosis, while biopsy was only done in the last one. ConclusionCombination of multiple examinations can improve the accuracy of diagnosis of this disease. However, the preoperative diagnosis is not completely believable, and it is necessary to perform the pathological examination during operation. Pancreatoduodenectomy should be used as the first choice for pancreatic duct stone with pancreatic cancer.

Citation： YANG Wei,ZHENG Xin,LIU Qingguang,YAO Yingmin,YU Liang. Retrospective Analysis of Diagnosis and Treatment of 10 Cases of Pancreatic Duct Stone Complicated with Pancreatic Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(2): 141-144. doi: Copy

1.	1张国伟，周杰，李朝龙,等.胰石症的诊断与治疗体会(附16例报告) [Ｊ]. 中华肝胆外科杂志， 2003； 9 (11)： 648 2李建水，张肇达，唐勇，等. 胰管结石的临床分析 [Ｊ]. 中国普外基础与临床杂志,2006; 13(4)： 456.
2.	10Paulino-Netto A, Dreiling DA, Baronofsky ID. The relationship between pancreatic calcification and cancer of the pancreas [Ｊ]. Ann Surg,1960; 151(4)： 530 11Machiki Y, Nimura Y, Kamiya J,et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones [Ｊ]. Int J Pancreatol,1997; 22(3)： 187.
3.	Saraya A, Acharya SK, Vashist S, et al. A pancreatography study of chronic calcific pancreatitis of the tropics [Ｊ]. Trop Gastroenterol,2002; 23(4)： 167.
4.	熊先泽，敬静，彭其芳. 胰管结石慢性胰腺炎的诊治 [Ｊ]. 中国普外基础与临床杂志,2007; 14（1）： 94.
5.	Patard L,Lallemand JY,Stoven V.An insight into the role of human pancreatic lithostathine [Ｊ]. JOP,2003; 4(2)： 92.
6.	Jin CX, Naruse S, Kitagawa M,et al. Pancreatic stone protein of pancreatic calculi in chronic calcified pancreatitis in man [Ｊ]. JOP,2002; 3(2)： 54.
7.	Nakamura M, Oka M, Iizuka N, et al. Osteopontin expression in chronic pancreatitis [Ｊ]. Pancreas,2002; 25(2)： 182.
8.	Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis [Ｊ]. Digestion,1998; 59 Suppl 4： 49.
9.	Nagai H, Ohtsubo K. Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis [Ｊ]. Gastroenterology,1984; 86(2)： 331.
10.	何振平, 邓有松, 马宽生, 等. 胰管结石与并发胰腺癌 [Ｊ]. 中华肝胆外科杂志,2002; 8(2)： 90.
11.	Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status [Ｊ]. AJR Am J Roentgenol,1995; 165(5)： 1175.
12.	Procacci C, Graziani R, Bicego E, et al.Intraductal mucin-producing tumors of the pancreas: imaging findings [Ｊ]. Radiology,1996; 198(1)： 249.
13.	Kahl S, Glasbrenner B, Zimmermann S,et al. Endoscopic ultrasound in pancreatic diseases [Ｊ]. Dig Dis,2002; 20(2)： 120〖ＺＫ).
14.	Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [Ｊ]. Cancer, 1992; 70(11)： 2610.
15.	刘训良, 杜竞辉, 戴存才，等.胰液细胞学检查与PCR-SSP诊断胰腺癌之比较 [Ｊ]. 中华肝胆外科杂志, 1999; 5(2)： 106.
16.	Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [Ｊ]. Hepatogastroenterology, 1999; 46(25)： 31.
17.	周国雄，黄介飞，张弘，等. 内镜下胰液收集及肿瘤标记物检测对胰腺癌的诊断价值 [Ｊ].临床内科杂志,2005;22(6)： 397.
18.	Tada M, Komatsu Y, Kawabe T, et al. Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor [Ｊ]. Am J Gastroenterol,2002; 97(9)： 2263.
19.	Liu F, Li ZS, Xu GM, et al. Detection of K-ras gene mutation at codon 12 by pancreatic duct brushing for pancreatic cancer [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(2)： 313.
20.	Yu XJ, Long J, Fu DL, et al. Analysis of gene expression profiles in pancreatic carcinoma by using cDNA microarray [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(3)： 467.
21.	Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success [Ｊ]. Gastrointest Endosc,2002; 56(4)： 501.
22.	Ozkan H, Kaya M, Cengiz A. Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer [Ｊ]. Hepatogastroenterology,2003; 50(53)∶1669.
23.	Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era? [Ｊ]. JOP,2006; 7(4)： 332.
24.	彭承宏，程东峰，沈柏用，等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(5)： 506.
25.	孙备, 陈华. 胰腺癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志,2008; 15(8)： 547.
26.	Fang WL, Shyr YM, Su CH. Long-term follow-up study of surgical treatment for pancreatic stones [Ｊ]. Hepatogastroenterology,2007; 54(73)： 246.
27.	Choi KS, Kim MH. Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones [Ｊ].J Hepatobiliary Pancreat Surg,2006; 13(2)： 86.

1. 1张国伟，周杰，李朝龙,等.胰石症的诊断与治疗体会(附16例报告) [Ｊ]. 中华肝胆外科杂志， 2003； 9 (11)： 648 2李建水，张肇达，唐勇，等. 胰管结石的临床分析 [Ｊ]. 中国普外基础与临床杂志,2006; 13(4)： 456.
2. 10Paulino-Netto A, Dreiling DA, Baronofsky ID. The relationship between pancreatic calcification and cancer of the pancreas [Ｊ]. Ann Surg,1960; 151(4)： 530 11Machiki Y, Nimura Y, Kamiya J,et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones [Ｊ]. Int J Pancreatol,1997; 22(3)： 187.
3. Saraya A, Acharya SK, Vashist S, et al. A pancreatography study of chronic calcific pancreatitis of the tropics [Ｊ]. Trop Gastroenterol,2002; 23(4)： 167.
4. 熊先泽，敬静，彭其芳. 胰管结石慢性胰腺炎的诊治 [Ｊ]. 中国普外基础与临床杂志,2007; 14（1）： 94.
5. Patard L,Lallemand JY,Stoven V.An insight into the role of human pancreatic lithostathine [Ｊ]. JOP,2003; 4(2)： 92.
6. Jin CX, Naruse S, Kitagawa M,et al. Pancreatic stone protein of pancreatic calculi in chronic calcified pancreatitis in man [Ｊ]. JOP,2002; 3(2)： 54.
7. Nakamura M, Oka M, Iizuka N, et al. Osteopontin expression in chronic pancreatitis [Ｊ]. Pancreas,2002; 25(2)： 182.
8. Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis [Ｊ]. Digestion,1998; 59 Suppl 4： 49.
9. Nagai H, Ohtsubo K. Pancreatic lithiasis in the aged. Its clinicopathology and pathogenesis [Ｊ]. Gastroenterology,1984; 86(2)： 331.
10. 何振平, 邓有松, 马宽生, 等. 胰管结石与并发胰腺癌 [Ｊ]. 中华肝胆外科杂志,2002; 8(2)： 90.
11. Buetow PC, Parrino TV, Buck JL, et al. Islet cell tumors of the pancreas: pathologic-imaging correlation among size, necrosis and cysts, calcification, malignant behavior, and functional status [Ｊ]. AJR Am J Roentgenol,1995; 165(5)： 1175.
12. Procacci C, Graziani R, Bicego E, et al.Intraductal mucin-producing tumors of the pancreas: imaging findings [Ｊ]. Radiology,1996; 198(1)： 249.
13. Kahl S, Glasbrenner B, Zimmermann S,et al. Endoscopic ultrasound in pancreatic diseases [Ｊ]. Dig Dis,2002; 20(2)： 120〖ＺＫ).
14. Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [Ｊ]. Cancer, 1992; 70(11)： 2610.
15. 刘训良, 杜竞辉, 戴存才，等.胰液细胞学检查与PCR-SSP诊断胰腺癌之比较 [Ｊ]. 中华肝胆外科杂志, 1999; 5(2)： 106.
16. Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [Ｊ]. Hepatogastroenterology, 1999; 46(25)： 31.
17. 周国雄，黄介飞，张弘，等. 内镜下胰液收集及肿瘤标记物检测对胰腺癌的诊断价值 [Ｊ].临床内科杂志,2005;22(6)： 397.
18. Tada M, Komatsu Y, Kawabe T, et al. Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinical utility for diagnosis of pancreatic tumor [Ｊ]. Am J Gastroenterol,2002; 97(9)： 2263.
19. Liu F, Li ZS, Xu GM, et al. Detection of K-ras gene mutation at codon 12 by pancreatic duct brushing for pancreatic cancer [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(2)： 313.
20. Yu XJ, Long J, Fu DL, et al. Analysis of gene expression profiles in pancreatic carcinoma by using cDNA microarray [Ｊ]. Hepatobiliary Pancreat Dis Int,2003; 2(3)： 467.
21. Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success [Ｊ]. Gastrointest Endosc,2002; 56(4)： 501.
22. Ozkan H, Kaya M, Cengiz A. Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer [Ｊ]. Hepatogastroenterology,2003; 50(53)∶1669.
23. Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era? [Ｊ]. JOP,2006; 7(4)： 332.
24. 彭承宏，程东峰，沈柏用，等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(5)： 506.
25. 孙备, 陈华. 胰腺癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志,2008; 15(8)： 547.
26. Fang WL, Shyr YM, Su CH. Long-term follow-up study of surgical treatment for pancreatic stones [Ｊ]. Hepatogastroenterology,2007; 54(73)： 246.
27. Choi KS, Kim MH. Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones [Ｊ].J Hepatobiliary Pancreat Surg,2006; 13(2)： 86.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Retrospective Analysis of Diagnosis and Treatment of 10 Cases of Pancreatic Duct Stone Complicated with Pancreatic Cancer

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