胰管结石40例诊治体会

目的探讨胰管结石合理的分型及个体化治疗方式。方法回顾性分析2004年10月至2014年5月我院收治的40例胰管结石患者的临床资料,男性20例,女性20例,平均年龄(37±12)岁。所有患者均术前确诊,其中确诊率B超88.6%(31/35),CT为77.4%(24/31),MRCP为92.6%(25/27)。手术治疗27例,内镜治疗13例,采用陈勇军等提出的胰管结石分型对其分型。结果根据结石的位置、胰管有无狭窄及术中探查结果,将胰管结石分为3型:Ⅰ型16例,胰管结石位于主胰管,7例行胰管切开取石+胰管空肠Roux-en-Y吻合,9例行ERCP取石,其中6例ERCP取石+支架,3例ERCP取石+ENPD;Ⅱ型20例,胰管结石位于主胰管和分支胰管,均行胰管切开取石+胰管空肠Roux-en-Y吻合,合并胰尾切除1例,胰十二指肠切除1例,Frey手术1例;Ⅲ型4例,胰管结石位于分支胰管,主要行ERCP胰管支架引流。全组无死亡病例,术后胰瘘1例(3.7%),内镜治疗后急性胰腺炎1例(7.7%),结石残留8例(20%),4例Ⅱ型结石,4例为分支胰管结石。38例获得随访,至今生存,疼痛症状均明显缓解。结论胰管结石处理复杂,正确的分型对其个体化治疗具有重要意义,胰管切开取石+胰管空肠Roux-en-Y吻合仍是外科治疗首选手术方式,内镜技术已然成为一种重要的治疗手段。

The diagnosis and treatment experience of 40 cases with pancreatic duct stones

Objective To evaluate the reasonable type and individualized treatment of pancreatic duct stone. Methods 40 patients diagnosed with pancreatic duct stone which were admitted in our hospital from October 2004 to May 2014 were enrolled in the study retroprospectively. Of the 40 patients enrolled,20 males and 20 females,the average age was 37 ± 12. All patients were diagnosed definitely before operation. The diagnosed rate of B-ultrasound was 88. 6%（31 /35）,the diagnosed rate of Computed Tomography was 77. 4%（24 /31）,and the diagnosed rate of MRCP was 92. 6%（25 /27）. 27 patients underwent the surgical treatment and13 patients underwent the endoscopic therapy. The type of the pancreatic duct stone were differed according to the Yong-Jun chens＇ pancreatic duct stone typing methods. Results According to the position of the stone,the diameter of the pancreatic duct and the surgical exploration,the 40 patients were divided into 3 groups： TypeⅠ concluded of 16 patients the stone located in the main pancreatic duct and there were 7 patients underwent the pancreatic duct incision and pancreaticojejunostomy,the other 9 patients underwent the ERCP procedure; TypeⅡ concluded of 20 patients,the stone located in the main or branch pancreatic duct,and all underwent the pancreaticojejunostomy; Type Ⅲ concluded of 4 patients,the stone located in the branch pancreatic duct,all were treated with the endoscopy therapy. There were no patient die in the follow-up. The postoperative pancreatic fistula was 3. 7%（1 /40）,the Post-ERCP Pancreatitis rate was 3. 7%（1 /40）. 8 patients developed the pancreatic duct stone after the first treatment. All the patients were survived during the follow-up. Conclusion The treatment and diagnose of the pancreatic duct stone still remains complicated. The accurate classification and individual treatment are important. The pancreatic duct incision and Roux-en-Y pancreaticojejunostomy is the first surgical choice. Also the endoscopy treatment is indispensable and valuable.