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慢性胰腺炎的手术方式选择

田孝东, 高红桥, 陈国卫, 庄岩, 杨尹默

田孝东, 高红桥, 陈国卫, 等. 慢性胰腺炎的手术方式选择[J]. 中华消化外科杂志, 2014, 13(4): 263-267. DOI: 10.3760/cma.j.issn.1673-9752.2014.04.007
引用本文: 田孝东, 高红桥, 陈国卫, 等. 慢性胰腺炎的手术方式选择[J]. 中华消化外科杂志, 2014, 13(4): 263-267. DOI: 10.3760/cma.j.issn.1673-9752.2014.04.007
Tian Xiaodong, Gao Hongqiao, Chen Guowei, et al. Surgical procedure selection for chronic pancreatitis[J]. Chinese Journal of Digestive Surgery, 2014, 13(4): 263-267. DOI: 10.3760/cma.j.issn.1673-9752.2014.04.007
Citation: Tian Xiaodong, Gao Hongqiao, Chen Guowei, et al. Surgical procedure selection for chronic pancreatitis[J]. Chinese Journal of Digestive Surgery, 2014, 13(4): 263-267. DOI: 10.3760/cma.j.issn.1673-9752.2014.04.007

慢性胰腺炎的手术方式选择

基金项目: 国家自然科学基金(81172184,81372605); 北京市自然科学基金(7122188)

Surgical procedure selection for chronic pancreatitis

  • 摘要:

    目的:探讨慢性胰腺炎外科治疗的手术方式选择。
    方法:回顾性分析2000年1月至2013年8月北京大学第一医院收治的80例慢性胰腺炎患者的临床资料,其中胰管扩张>7 mm、伴或不伴胰管结石者38例,胆总管扩张者44例,伴有胰头部炎性肿块者32例,脾大伴食管胃底静脉曲张3例。根据患者临床症状及影像学表现综合判断手术指征及选择手术方式。根据VAS疼痛分级标准评估患者术后疼痛缓解及复发。通过门诊复查、信件或电话访谈方式随访,随访时间截至2013年12月。
    结果:胆肠吻合术27例,Partington-Rochelle术24例,Partington-Rochelle术+胆肠吻合术6例,胰十二指肠切除术7例,胰体尾切除术4例,Beger术3例,脾切除术3例,Frey术+胰头内胆管开窗术3例,Frey术2例,胆总管探查+T管引流术1例。63例以腹痛为主要表现的患者术后腹痛缓解率达95.2%(60/63)。围手术期1例患者因腹腔感染并发MODS死亡。围手术期并发症7例,包括腹腔感染3例、胰瘘2例、胆瘘1例、腹腔出血1例,所有并发症经保守治疗治愈。79例患者获得随访,平均随访时间为58.6个月(4~156个月)。30例腹痛复发或出现新发腹痛症状,总复发率为38.0%(30/79)。32例胰头部炎性肿块患者中,17例因胆管扩张合并梗阻性黄疸仅行胆肠吻合术,术后腹痛复发率达9/17;另15例分别行胰十二指肠切除术、Beger术或Frey术,术后腹痛复发率为1/15。41例胰腺萎缩或弥漫炎性改变患者中,10例仅行胆肠吻合术者腹痛复发率达7/10;30例Partington-Rochelle术患者腹痛复发率为33.3%(10/30)。
    结论:对胰管扩张的慢性胰腺炎患者,充分引流可有效缓解症状;对于胰头部炎性肿块慢性胰腺炎患者,应选择手术切除或联合术式。

    Abstract:

    Objective: To investigate the surgical procedure selection for chronic pancreatitis.
    Methods: The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed. Thirty-eight patients were with or without pancreatic duct stone, and the dilation of the pancreatic duct was above 7 mm, 44 patients were with common bile duct dilation, 32 patients were with inflammatory mass in the head of the pancreas, and 3 patients were with splenomegaly and esophagogastric varices. Surgical procedures were selected according to the symptoms and results of imaging examination. The remission or recurrence of pain was judged according to the visual analog scales. Patients were followed up via out-patient examination, mail or phone call till December 2013.
    Results: Choledochojejunostomy was done on 27 patients, Partington-Rochelle pancreaticojejunostomy on 24 patients, Partington-Rochelle pancreaticojejunostomy+choledochojejunostomy on 6 patients, pancreaticoduodenectomy on 7 patients, resection of the body and tail of the pancreas on 4 patients, Beger′s procedure on 3 patients, splenectomy on 3 patients, Frey′s procedure+fenestration of bile duct in the head of the pancreas on 3 patients, Frey′s procedure on 2 patients, common bile duct exploration+T tube drainage on 1 patient. The remission rate of abdominal pain was 95.2%(60/63). One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively. Three patients were complicated with abdominal infection, 2 with pancreatic fistula, 1 with biliary fistula and 1 with abdominal bleeding. All the complications were cured by conservative treatment. Seventy-nine patients were followed up, and the mean time of follow-up was 58.6 months (range, 4-156 months). Thirty patients had recurrence or new onset of abdominal pain, and the recurrence rate was 38.0% (30/79). Of the 32 patients with inflammatory mass in the head of the pancreas, 17 received choledochojejunostomy, and the recurrence rate of abdominal pain was 9/17; the other 15 patients received pancreatoduodenectomy, Beger′ procedure or 〖HJ*4〗Frey′s procedure, and the recurrence rate of abdominal pain was 1/15. Of the 41 patients without inflammatory mass, 10 received choledochojejunostomy, and the recurrence rate of abdominal pain was 7/10; 30 received Partington-Rochelle pancreaticojejunostomy, and the recurrence rate of abdominal pain was 33.3%(10/30).
    Conclusions: Complete drainage could relieve the symptoms for patients with pancreatic duct dilation. Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.

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