胰头部肿块型慢性胰腺炎诊断与治疗

胰头部肿块型慢性胰腺炎从临床表现上很难与胰头癌相鉴别，目前已将发生于胰头部的肿块型慢性胰腺炎视为胰腺癌发生的癌前病变。影像学检查在肿块型慢性胰腺炎诊断中起着重要作用，对于手术指征的掌握、胰头部肿块的可切除性、手术方式的选择以及手术困难程度的估计很有帮助。胰头部肿块型慢性胰腺炎的手术方式是直接针对胰头的，不同的手术方法包括胰十二指肠切除术（保留或不保留幽门的Whipple手术）和胰头部分切除加胰管引流术（Frey 手术，Beger 手术）。胰头肿块型慢性胰腺炎一旦诊断明确即应积极手术治疗，手术方式尽可能采用胰十二指肠切除术，因为它不仅切除了胰头部肿块、解除了胆道和胰管及十二指肠的梗阻，而且也去除了胰头癌的潜在病因；如胰头肿块巨大，行胰十二指肠切除有极大风险，可考虑行保留十二指肠的胰头切除术。

Diagnosis and treatment of chronic pancreatitis with mass in the head of the pancreas

Diagnosis and treatment of chronic pancreatitis with mass in the head of the pancreas ZHANG Zhong-tao, YIN Jie.Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences, Beijing 100050, China Corresponding author: ZHANG Zhong-tao, E-mail: zhangzht@medmail. com.cn Abstract Chronic pancreatitis (CP) with mass and pancreatic cancer are difficult to identify from the Clinical performance. At present, we have the CP with mass as a precancerous lesion of pancreatic cancer. Imaging methods in the diagnosis of the CP with mass plays an important role, which is very helpful for the Indications for surgery of the hands, of resectable pancreatic head tumor, and surgical options, as well as estimates of the difficulty of the surgery. Surgical strategy in CP with mass has been directed at the pancreatic head with a variety of tactics including pancreatoduodenectomy(Whipple procedure with or without pylorus preservation) and partial resection of the pancreatic duct drainage(Frey operation, Beger operation ). Once the diagnosis of the CP with mass should be clear that the surgical treatment, pancreatoduodenectomy is preformed in the treatment of CP with mass, not only resection of the pancreatic head mass, the lifting of the bile duct and pancreatic duct and obstruction of the duodenum, but also in addition to the potential causes of pancreatic cancer. Pancreatoduodenectomy is great risk When the great mass of pancreatic head, but the partial head resection can be accomplished with relative safety.