胰头肿块型胰腺炎治疗策略的选择及预后分析

目的探讨胰头肿块型胰腺炎患者治疗策略的选择及预后。方法回顾性分析我科2001年1月~2011年12月收治的胰头肿块型胰腺炎患者的临床资料,并对患者治疗策略的选择及预后情况进行总结。结果共纳入50例胰头肿块型胰腺炎患者,其中76%（38/50）的胰头肿块为实质性,24%（12/50）为囊性肿块。在38例胰头实质性肿块患者中,有26例行手术治疗,12例行非手术治疗,在手术治疗的26例患者中,12例行胰十二指肠切除术,7例行保留十二指肠的胰头次全切除术,4例行胆管空肠Y型吻合,3例行胰管空肠Y型吻合。在12例囊性肿块患者中,有8例患者行手术治疗,其中假性囊肿外引流术3例,空肠囊肿吻合术3例,囊肿局部切除术2例。胰头实质性肿块患者术后病理确诊为慢性胰腺炎仅5例（26.3%,5/19）,胰腺癌9例（47.4%,9/19）,黏液状乳头状腺瘤3例（15.8%,3/19）,神经内分泌肿瘤和胰腺不典型增生各1例（5.3%,1/19）。未接受手术治疗的12例胰头实质性肿块患者中,有7例（58.3%）发生肝转移临床诊断为胰腺癌。接受手术治疗的26例胰头实质性肿块患者中,3例患者术后出现胆瘘,1例术后出现胰瘘,2例术后出现胃瘫;9例病理确诊为胰腺癌的患者在随访过程中有2例（22.2%）发生肝转移。对于胰头实质性肿块患者,手术治疗和非手术治疗患者的5年存活率差异有统计学意义（92.3%vs 41.7%,P〈0.05）。结论对胰头实质肿块型胰腺炎患者,应适当放宽手术指证以提高患者预后,提倡以手术切除胰头肿块为宜。

Treatment strategy and prognosis of chronic pancreatitis with mass in the head of pancreas

Objective To investigate the choice of treatment strategy and prognosis of chronic pancreatitis with mass in the head of pancreas.Methods The clinical data of hospitalized patients between January 2001 and December 2011 were collected,and the choices of treatment strategy and prognosis of patients were retrospectively analyzed.Results A total of 50 patients were included in this study,consisting of 76%（38/50） with parenchymal mass and 24%（12/50） with cystic mass.Among the 38 patients with parenchymal mass,26 patients received surgery including 12 patients with pancreatoduodenectomy,7 patients with duodenum-preserving pancreatic head and subtotal resection,4 patients with Y-shaped anastomosis of bile duct jejunum,and 3 patients with Y-shaped anastomosis of pancreatic duct jejunum.Among the 12 patients with cystic mass,8 patients received surgery,including 3 patients with external drainage of pseudocyst,3 patients with jejunum cyst anastomosis,and 2 patients with cyst partial resection.Postoperative pathology results confirmed that there were only 5（26.3%,5/19） patients with chronic pancreatitis,while 9（47.4%,9/19） patients with pancreatic cancer,3（15.8%,3/19） patients with papillary adenoma of the mucoid,1 patient with neuroendocrine tumor,and 1 patient with atypical hyperplasia.Among the 12 patients with parenchymal mass not undergoing surgery,7（58.3%） patients occurred liver metastases and clinical diagnosed of pancreatic cancer.Among the 26 patients with parenchymal mass undergoing surgery,3 patients with biliary fistula,1 patient with pancreatic fistula,and 2 patients with gastroparesis.Among the 9 patients diagnosed as pancreatic cancer after surgery,2 patients were developed to liver metastases during follow-up.The difference in 5-year survival rate between surgery and non-surgical treatment group differences were statistically significant（94.7% vs 41.7%,P 0.05）.Conclusion For chronic pancreatitis patients with mass in the head of pancreas,it is necessary to relax the indications for surgery so as to improve the prognosis of patients,and surgical removal of the head of the pancreas tumor is recommended.