2024年 · 第39卷第09期

A 38-year-old male was admitted to the hospital with "abdominal discomfort for more than 1 year, and CA19-9 was found to rise for 1 day". In the past year, the patient had intermittent dull pain in the upper abdomen, which could be relieved by itself, and there was no other discomfort such as nausea and vomiting. There was no obvious abnormality in CT examination in other hospitals 1 year ago, and the patient did not receive special treatment. One day ago, the tumor marker CA19-9 was found to be 734 U/ml. Enhanced CT examination in our hospital showed that there was a round shadow with a slightly lower density between the caudate lobe of the liver and the pancreas, with a size of about 3.3 cm ×3.0 cm ×3.5 cm. Enhanced scan showed enhanced mass separation and enhanced wall nodules, which was considered as a tumor-like lesion. MRI enhanced and magnetic resonance cholangiopancreatography (MRCP) examination showed (Figures 1 and 2) that the main pancreatic duct was not obviously dilated, and the upper edge of the pancreas neck was not obviously connected with the main pancreatic duct. The lesions showed multilocular long T1 and long T2 signals, with a size of about 2.6 cm ×3.5 cm ×3.3 cm, with separation in it, and enhanced cyst wall and separation in enhanced scan. No significant dilatation of the pancreatic duct was observed; There were no obvious enlarged lymph nodes in the hilar area and retroperitoneal area. PET-CT showed a slightly low-density cystic shadow in the neck of the pancreas, with slightly higher marginal and separation metabolism in the early and delayed images. It was considered as a neoplastic lesion, suspected of cystadenoma or cystadenocarcinoma. "Laparoscopic enucleation of pancreatic mass" was performed. During the operation, it was seen that a soft exogenous mass about 3.5 cm in size above the neck of the pancreas, with clear boundaries, close relationship with the pancreas and poor mobility. The surgeon peeled along the edge of the mass together with a small amount of pancreatic tissue, and completely peeled the tumor. The gray-white tofu-like content in the cyst can be seen when the mass is incised. Intraoperative freezing pathology: pancreatic lymphoepithelial cyst may be. Routine postoperative pathology: pancreatic lymphoepithelial cysts (PLECs), and one lymph node showed reactive hyperplasia (Figure 3). The patient was complicated with mild grade A pancreatic leakage without complications such as hemorrhage and gastric emptying disorder. The CA19-9 was 131 U/ml on the 8th day after operation, and the patient was discharged on the 12th day after operation. CA19-9 dropped to the normal range after 1 month of reexamination, and the patient had no special discomfort, so he was instructed to have regular reexamination.

A 63-year-old male was admitted for "intermittent hematochezia for 3 days". He has a history of chronic pancreatitis and pancreatic pseudocyst for 19 years, and is addicted to alcohol for more than 40 years, with an amount of about 500 ml/d (liquor). Physical examination: apathy, anemic appearance, whole body damp and cold, heart rate 143 beats/min, blood pressure 80/50 mmHg, upper abdominal tenderness, intestinal sounds 6-8 beats/min, no special remaining. Auxiliary examination: blood routine: hemoglobin 42 g/L. Duodenoscopy: Blood spillage is visible from the nipple (Figure 1). ERCP examination: dark red blood in the descending part of the duodenum, pancreatic duct intubation was selected, and dark red blood flowed out. Upper abdominal enhanced CT: A nodular enhanced shadow, about 1.1 cm ×1.6 cm in size, can be seen in the annular high-density shadow of the body of the pancreas, considering rupture of splenic artery pseudoaneurysm (Figure 2). Surgical exploration: The appearance of the pancreas was consistent with the manifestations of chronic pancreatitis, with a large number of blood clots in the cyst cavity of the pancreatic body. After clearing the blood clots, splenic artery rupture and bleeding were seen. Pancreatic pseudocyst resection and combined splenectomy of the body and tail of the pancreas were performed, and the postoperative recovery was good. Follow-up for 5 years showed no recurrence of gastrointestinal bleeding.