胰头肿块型胰腺炎的诊断与治疗

胰头肿块型慢性胰腺炎从临床表现上很难与胰头癌相鉴别,影像学检查在肿块型慢性胰腺炎诊断中起重要作用,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.目前已将发生于胰头的肿块型慢性胰腺炎视为胰腺癌发生的癌前病变.胰头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)和胰头部分切除(Beger手术)加胰管引流术(Frey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;若胰头肿块巨大胰十二指肠切除有极大风险,可考虑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

Chronic pancreatitis (CP) with mass and pancreatic cancer are difficult to identify from the Clinical performance. Imaging methods in the diagnosis of the CP with mass play 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. At present, we have taken the CP with mass as a precancerous lesion of pancreatic cancer. 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 was confirmed surgical treatment should be performed by pancreatoduodenectomy, which by not only the pancreatic head mass was resected, the bile ducts and pancreatic ducts and obstruction of the duodenum were lifted, but also the potential causes of pancreatic cancer were ruled out. Pancreatoduodenectomy has great risk for the big mass of pancreatic head, but the partial head resection can be accomplished with relative safety.