从病理解剖学探讨慢性胰腺炎手术治疗的合理性

目的 探讨病理解剖学改变对慢性胰腺炎手术方式选择的指导意义,评价外科治疗的远近期效果,为设计合理化手术方案提供临床依据。方法 回顾性研究北京大学第一医院2000-2010年外科治疗60例慢性胰腺炎病人的临床资料。结果 围手术期死亡1例（1.7%）。60例慢性胰腺炎病人合并腹痛43例（71.7%）,42例手术后疼痛获缓解,远期复发17例（40.5％）。合并胰管扩张和（或）胰管结石行改良Puestow术21例,远期复发8例（38.1%）;6例行不同范围胰头切除术者未见症状复发,11例仅行胆肠吻合者2年内疼痛复发9例（81.2%）。合并胆道梗阻者33例（55%）,单纯或联合其他手术的胆肠吻合均能缓解黄疸,单纯胆肠吻合后33.3%（4/12）新发腹痛,5例胰头切除术后病人长期随访无黄疸和腹痛复发。结论 根据慢性胰腺炎病理解剖学改变选择具针对性手术效果良好,合理的切除加充分的胰胆引流可显著改善临床症状。     

慢性胰腺炎的外科治疗

目的 改善慢性胰腺炎的外科治疗效果。方法 回顾性分析我院外科1983－2000年收治的34例慢性胰腺炎病人的临床资料，并将其分为慢性钙化性胰腺炎及慢性梗阻性胰腺炎两组。结果 男性23例（68％），女性11例（32％），平均年龄52.89岁。嗜酒者23例（67.65%），合并胆石症者13例（38.24%），继往有急性胰腺炎发作者11例（32.35%）。主诉腹痛者28例（82.35%），合并黄疸者17例（50％），慢性钙化性胰腺炎与慢性梗阻性胰腺炎在某些临床表现间存在显著性差异，提示二者可能存在不同的发病机制。34 病人分别采用9种不同的手术方式，无围手术期死亡。Puestow手术及胰十二指肠切除可有效地缓解疼痛，并可改善胰外分泌功能，对胰内分泌的影响不大。Puestow手术并行胆肠吻合适于合并胆道狭窄的慢性胰腺炎病人，而仅行胆道引流效果不佳。结论 慢性胰腺炎的外科治疗应采用个体化原则，如合并胰管扩张可行Puestow引流手术，胰头炎性包块病人应行切除手术。     

胰头肿块型慢性胰腺炎的治疗

胰头肿块型慢性胰腺炎已被视为胰腺癌的癌前病变,并且可以导致胰管、胆管及十二指肠梗阻,其与胰头癌的鉴别诊断困难,然而二者的预后截然不同。因此,胰头肿块型慢性胰腺炎一旦诊断明确即应积极手术治疗,以切除病变,缓解疼痛症状,改善病人的生活质量。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）和保留十二指肠的胰头切除术（Beger手术及其改良术式）。手术方式尽可能采用胰十二指肠切除术,不仅切除了胰头部肿块、解除了胆道、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,行胰十二指肠切除术有极大风险,可考虑行保留十二指肠的胰头切除术。     

急性胆石性胰腺炎82例的临床与病理分析

分析８２例急性胆石性胰腺炎早期手术时的胆道系统和胰腺病理改变。结果表明：重症胰腺炎病理改变占２０．９％，住院期间死亡率３．７％。胆囊结石发现率为８５．５％，其中多数性结石占７１．１％，胆总管结石发现率为３６．８％，胆管扩张占５３．８％；胆囊管明显变粗，推测曾有过胆囊排石者占２６．４％；６８例术后造影发现有胆－胰汇合异常长型通道者占２０．１％，胆管远段狭窄占９．３％。以上资料说明急性胰腺炎诱发因素与反复胆囊排石导致胆管结石梗阻和胆管狭窄有明显关系，也与胆胰汇合异常有关（三种因素共占６４．４％）。作者认为若胆石性胰腺炎诊断明确，早期手术对愈后有利。     

慢性胰腺炎合并胰管结石的诊断和治疗

慢性胰腺炎是由于多种原因（酗酒、胆道系统疾病等）造成的胰腺组织结构和功能持续性损害,常合并胰管结石。疼痛是其最主要症状,同时常伴有消化不良、脂肪泻、糖尿病等并发症。结合多种影像学检查方法如B超、CT、ERCP和磁共振胰胆管造影（MRCP）等能明显提高慢性胰腺炎合并胰管结石的确诊率。慢性胰腺炎合并胰管结石应予以积极治疗,以控制症状、改善胰腺功能和治疗并发症为重点,强调以个体化治疗为原则的综合治疗。在体外震波碎石及内镜取石不彻底而症状不能控制或结石复发者应尽早手术治疗,根据结石分布范围选择相应的治疗方式,彻底去除病灶,取净结石,解除胰、胆管梗阻,充分引流胰液,同时注意尽量保存胰腺组织功能,可明显改善病人生存质量。     

慢性胰腺炎的CT表现对治疗选择的意义

目的探讨慢性胰腺炎CT形态学分型及其对治疗选择的指导作用。方法回顾分析经治疗证实的59例慢性胰腺炎的CT影像和治疗方法，结合文献总结讨论不同病理形态改变的慢性胰腺炎在治疗方法选择上的区别。结果59例中27例（46％）表现为全胰腺萎缩伴不同程度胰实质钙化，采取内科保守治疗：7例为单或多发囊肿型（12％）表现为胰腺及其周围多发假性囊肿形成，对最长径大于5cm者行切开引流和吻合：7例（12％）表现为胰管狭窄或扩张，行胰管减压引流术；5例（8％）为表现为胰头胰腺局限性软组织样肿块，全部手术切除。13例（22％）为以上两种或以上的混合表现，以外科手术为主。对合并有胆道梗阻的病例做减压引流。结论慢性胰腺炎可分萎缩钙化型、假性囊肿型、胰管狭窄或扩张型、肿块型、混合型5型，CT形态学分型对治疗方案选择及明确病因有一定的意义。     

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目的改善慢性胰腺炎的治疗效果？方法回顾性分析1985～2000年收治的58例慢性胰腺炎病人的治疗效果。结果33例接受非手术治疗的病人多数有效，但多有复发。经手术治疗的25例病人效果明显好于非手术治疗组。结论对胰头包块型慢性胰腺炎、梗阻型慢性胰腺炎、假性胰腺囊肿应手术治疗；对病变弥漫且无胰管梗阻者，应采取内科治疗，若药物难以控制，可采用胰腺去神经术；对合并胆石的慢性胰腺炎，应积极进行手术处理。     

胰管梗阻的诊断和治疗

提出胰管梗阻所致胰高压在胆胰疾病中造成病人剧烈腹痛和消化道功能紊乱的作用以及手术缓解胰高压的重要性。方法：２７例诊断为胰管梗阻的患者中,１１例为慢性胰腺炎,１６例为晚期胰腺癌或壶腹周围癌。其中慢性胰腺炎有６例为胰管多发性狭窄伴扩张,手术将胰管纵行劈开并与空肠行大口侧侧吻合,另５例仅出口狭窄者行胰管空肠侧端吻合;１６例晚期肿瘤患者,仅５例行胰管空肠内引流术。结果：１１例慢性胰腺炎内引流手术后经长期随访除一例偶有上腹轻度疼痛外,其余１０例症状均明显好转。其余消化道症状亦皆明显好转。１６例晚期肿瘤所致的胰管梗阻病人,５例行胰管空肠吻合术,术后病人疼痛均明显好转。结论：胰管阻塞可引起胰高压,后者可能是造成慢性疼痛和消化不良的重要原因,在胆胰手术过程中应充分地认识其重要性,以选择适当的术式。     

慢性胰腺炎合并胰管结石11例的诊治经验

目的 探讨慢性胰腺炎合并胰管结石的诊断与治疗。方法 对1996—2002年间11例慢性胰腺炎合并胰管结石患者的临床资料进行回顾性分析。结果 腹痛、腰背痛、内、外分泌功能障碍是慢性胰腺炎合并胰管结石的常见症状，B超、CT、逆行胰胆管造影检查均可明确诊断。本组中9例行胰管空肠引流术，1例合并胰头癌行胰十二指肠切除术，1例胰尾切除术，10例术后腹痛消失。结论 B型超声可作为胰管结石的首选检查方法；胰管切开取石和胰管空肠引流为胰管结石的合理术式；胰管结石易合并胰腺癌，应加以重视。     

慢性胰腺炎的手术方式选择

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〉7mm、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．O％（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。     

慢性胰腺炎的手术适应证和术式选择

目的提高慢性胰腺炎的外科治疗效果. 方法回顾性总结分析55例慢性胰腺炎外科治疗资料.发病因素:嗜酒5年以上、胆系结石、急性胰腺炎病史分别占38.2%,29.1%和20.0%.主要临床表现:慢性腹痛、梗阻性黄疸、体重减轻、消化不良、糖尿病分别为98.2%,38.2%,34.5%,20.0%和10.9%.全组均因慢性腹痛或伴有胰管和(/或)胆管梗阻、结石、胰腺钙化、肿块、假性囊肿等行外科治疗,共采用了10种术式. 结果无手术死亡和严重并发症.术后效果良好43例(78.2%),症状减轻好转10例(18.2%),无效2例(3.6%). 结论慢性胰腺炎长期慢性腹痛并胰胆管梗阻、结石、肿块、假性囊肿适于外科治疗,应根据病变类型和特点选择不同的术式.胰管梗阻扩张、结石或假性囊肿宜行胰管或囊肿空肠吻合,胰头肿块并胆、胰管梗阻可行胰头十二指肠切除或胆胰管空肠吻合术.     

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??Rationality of surgical managements according to the pathological anatomy of chronic pancreatitis GAO Hong-qiao, CAI Meng-shan, MA Yong-su, et al. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Corresponding author: YANG Yin-mo, E-mail: yangyinmo@263.net
Abstract Objective To investigate the outcome after surgery directed by pathological anatomy of chronic pancreatitis and provide evidence for surgical procedures. Methods The clinical material of 60 patients with chronic pancreatitis who underwent surgical treatment between 2000 and 2010 were investigated retrospectively. Result 43 cases (71.7%) presented with abdominal pain, Perioperative mortality was 1.7% (1 case). Forty-two patients with abdominal pain were all relieved after surgery, but long-term recurrence occered in 17 cases (40.5%). Modified Puestow procedure was performed on 21 patients with dilatation of pancreatic duct and/or lithiasis, long-term pain recurrence occered in 8 cases (38.1%); Six patients undergoing pancreatic head resection had no recurrence in the long-term follow-up; Pain recurrence rate of 11 cases with only cholangioenterostomy was 81.2% (9 cases) within 2 years. Chronic pancreatitis with common bile duct obstruction occurred in 33 cases(55%), cholangioenterostomy alone or combined with partly pancreatic resection or pancreatic duct drainage procedures could alleviate symptoms of biliary obstruction, 4(33.3%) cases after pure biliary drainage emerged abdominal pain, 5 cases of pancreatic head resection had no recurrence of jaundice and abdominal pain after long-term follow-up. Conclusion Surgical procedures should be selected according to the pathological anatomy of chronic pancreatitis. Reasonable pancreatic head resection and adequate bile and/or pancreatic drainage could significantly improve the long-term outcomes.     

Duodenum-preserving head resection in chronic pancreatitis

A duodenum-preserving head resection was performed in 295 patients with chronic pancreatitis and an inflammatory mass in the head of the pancreas. Ninety-four percent of patients suffered severe pain syndrome, 48% had a common bile duct stenosis, 17% a vascular obstruction in the portal vein and splenic vein branches, and 6% had a severe stenosis of the duodenum. Surgical resection of the inflammatory mass in the head of the pancreas was indicated after a medical treatment of 4.1 years (median). Subtotal resection of the head of the pancreas, including the inflammatory mass, resulted in decompression of the narrowed common bile duct segment, decompression of the pancreatic main duct, and the relief of duodenum stenosis, as well as a relief of portal hypertension. The mean hospitalization time was 13 days, frequency of re-operation 5.8%, and hospital mortality 1.02%. Seventy-nine percent of patients experienced long-lasting pain relief and 11% reported a significant and long-lasting reduction of pain; late morbidity proved to be low. In comparison to the Whipple procedure the duodenum-preserving head resection has the advantage of preserving the stomach, duodenum and biliary tract.     

Gastric outlet and duodenal obstruction from inflammatory pancreatic disease

During a ten-year period, 16 patients with gastric outlet and duodenal obstruction due to inflammatory pancreatic disease were seen. The cause of obstruction was chronic pancreatitis in ten patients, pseudocysts with associated pancreatitis in five patients, and pancreatic abscess in one patient. All patients had nausea and vomiting, 14 had abdominal pain, and five had weight loss greater than 4.5 kg. Diagnosis was made by plain abdominal film in one case, upper gastrointestinal tract roentgenographic series in 15 cases, and endoscopy in 11 cases. Mobilization of the duodenum relieved the obstruction in two patients. Fixed obstruction remained in 14 patients. This was relieved by gastrojejunostomy in 12 patients. Gastrojejunostomy was combined with drainage of a pseudocyst in three patients, a dilated pancreatic duct in three patients, and a dilated common bile duct in four patients. Obstruction was relieved by pseudocyst drainage in two patients. Associated common duct and pancreatic duct obstruction must be identified preoperatively.     

Complete obstruction of the lower common bile duct caused by autoimmune pancreatitis: is biliary reconstruction really necessary?

Recent observations suggest that an immune response is involved in the development of chronic pancreatitis. We report a case of autoimmune pancreatitis in a patient who showed complete obstruction of the lower common bile duct. A 63-year-old man was admitted to a local hospital, complaining of appetite loss and back pain. The patient had obstructive jaundice, and percutaneous transhepatic gallbladder drainage was performed. Fluorography through the biliary drainage catheter showed complete obstruction of the lower common bile duct. The patient had no history of alcohol consumption and no family history of pancreatic disease. Physical examination revealed an elastic hard mass palpable in the upper abdomen. Abdominal ultrasound and abdominal computed tomography (CT) scans showed enlargement of the pancreas head. While autoimmune pancreatitis was highly likely, due to the patients high serum immunoglobulin level, the possibility of carcinoma of the pancreas and/or lower common bile duct could not be ruled out. Laparotomy was performed, and wedge biopsy samples from the pancreas head and body revealed severe chronic pancreatitis with infiltration of reactive lymphocytes, a finding which was compatible with autoimmune pancreatitis. Cholecystectomy and biliary reconstruction, using choledochojejunostomy, were performed, because the complete bile duct obstruction was considered to be irreversible, due to severe fibrosis. After the operation, prednisolone (30mg/day) was given orally for 1 month, and the entire pancreas regressed to a normal size. Complete obstruction of the common bile duct caused by autoimmune pancreatitis has not been reported previously; this phenomenon provides an insight into autoimmune pancreatitis and provokes a controversy regarding whether biliary reconstruction is needed for the treatment of complete biliary obstruction caused by autoimmune pancreatitis.     

腹腔镜手术治疗腹腔镜胆囊切除术后再发胆管结石合并胰腺炎的临床体会

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后再发胆管结石合并胰腺炎再次行腹腔镜治疗的可行性、手术时机及手术经验。方法:回顾分析2011年5月至2013年5月20例患者LC术后再发胆管结石合并急性胰腺炎行腹腔镜治疗的临床资料。结果:19例患者顺利完成胆总管探查取石引流术,1例中转开腹,中转率5%。5例患者入院时合并急性胆管炎症状(Charcot三联征)急诊手术,3例为重症胰腺炎予以保守治疗效果不佳,1~3 d内行胆管探查的同时行胰包膜切开灌洗引流术。余者均为轻型胰腺炎未合并急性胆管炎,予以对症治疗待腹痛症状缓解,酶学指标正常后行腹腔镜胆总管探查术。术后2例患者胆管仍有残余小结石,术后3个月经胆道镜取出。结论:LC术后再发胆管结石合并急性胰腺炎再次行腹腔镜胆管探查取石术安全、可行。胆管结石合并急性胰腺炎患者内环境紊乱,病情相对复杂,手术时机的把握、腔镜下胰包膜切开灌洗引流对重症胰腺炎的恢复至关重要。     

Combined pancreatic duct and upper gastrointestinal and biliary tract drainage in chronic pancreatitis

In 55 patients undergoing pancreaticojejunostomy for intractable abdominal pain, common bile duct obstruction occurred in 29% (16/55) and duodenal obstruction occurred in 15% (8/55). Serum alkaline phosphatase and total and direct serum bilirubin levels were significantly higher in patients with intrapancreatic common bile duct stenosis. Transient upper gastrointestinal (UGI) tract obstruction was common with chronic pancreatitis; however, if symptoms persisted beyond 2 weeks, fixed duodenal obstruction was likely. Endoscopic retrograde cholangiopancreatography and UGI roentgenograms and endoscopy were useful in confirming mechanical obstruction to the biliary and UGI tracts, respectively. There was no difference in operative mortality and morbidity from combined drainage procedures compared with pancreaticojejunostomy alone. The biliary and UGI tracts should be investigated in symptomatic patients both before and after pancreaticojejunostomy. Combined drainage of the pancreatic duct and UGI and biliary tract is safe and effective treatment for obstructing complications of chronic pancreatitis.     

胰管开口炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗

目的 探讨胰管开口部位炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗方式.方法 对我院自2002年1月至2010年11月收治的28例慢性阻塞性胰腺炎患者的临床资料进行回顾性总结.其中13例患者血清淀粉酶和脂肪酶升高伴有反复急性腹痛,经影像学检查显示胰管全程扩张改变,外科探查明确诊断为胰管开口部位炎性病变导致的慢性阻塞性胰腺炎.对此13例患者的临床表现、诊断方法、手术探查发现和治疗方法进行分析,并对术后的状况包括疼痛复发、生活质量、胰腺的影像学变化和血清胰腺酶学进行随访观察.结果 13例患者均具有典型的慢性阻塞性胰腺炎的临床表现,但12例患者的影像学表现有别于十二指肠乳突、壶腹或胰腺导管内肿瘤导致的慢性阻塞性胰腺炎的图像特征,手术探查和影像学揭示多数患者的胆胰共同通道过短或存在胰腺分裂畸形,对12例患者实施十二指肠乳突、壶腹及胰管开口切开成形术或副乳突切开成形术,术后随访结果显示均未再伴有胰腺酶学升高的急性腹痛发作.结论 以胰管扩张为主而不伴有胆管慢性梗阻是胰管开口炎性病变导致的慢性阻塞性胰腺炎的影像学特征,十二指肠乳突炎症或副乳突炎症时容易在过短的胆胰共同通道或胰腺分裂畸形的患者中引发胰管开口的狭窄而发生慢性阻塞性胰腺炎,纠正胰管开口狭窄、改善胰管引流的局部成形术是简单、有效的治疗方法.     

胰管开口炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗

目的 探讨胰管开口部位炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗方式.方法 对我院自2002年1月至2010年11月收治的28例慢性阻塞性胰腺炎患者的临床资料进行回顾性总结.其中13例患者血清淀粉酶和脂肪酶升高伴有反复急性腹痛,经影像学检查显示胰管全程扩张改变,外科探查明确诊断为胰管开口部位炎性病变导致的慢性阻塞性胰腺炎.对此13例患者的临床表现、诊断方法、手术探查发现和治疗方法进行分析,并对术后的状况包括疼痛复发、生活质量、胰腺的影像学变化和血清胰腺酶学进行随访观察.结果 13例患者均具有典型的慢性阻塞性胰腺炎的临床表现,但12例患者的影像学表现有别于十二指肠乳突、壶腹或胰腺导管内肿瘤导致的慢性阻塞性胰腺炎的图像特征,手术探查和影像学揭示多数患者的胆胰共同通道过短或存在胰腺分裂畸形,对12例患者实施十二指肠乳突、壶腹及胰管开口切开成形术或副乳突切开成形术,术后随访结果显示均未再伴有胰腺酶学升高的急性腹痛发作.结论 以胰管扩张为主而不伴有胆管慢性梗阻是胰管开口炎性病变导致的慢性阻塞性胰腺炎的影像学特征,十二指肠乳突炎症或副乳突炎症时容易在过短的胆胰共同通道或胰腺分裂畸形的患者中引发胰管开口的狭窄而发生慢性阻塞性胰腺炎,纠正胰管开口狭窄、改善胰管引流的局部成形术是简单、有效的治疗方法.     

胰管开口炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗

目的 探讨胰管开口部位炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗方式.方法 对我院自2002年1月至2010年11月收治的28例慢性阻塞性胰腺炎患者的临床资料进行回顾性总结.其中13例患者血清淀粉酶和脂肪酶升高伴有反复急性腹痛,经影像学检查显示胰管全程扩张改变,外科探查明确诊断为胰管开口部位炎性病变导致的慢性阻塞性胰腺炎.对此13例患者的临床表现、诊断方法、手术探查发现和治疗方法进行分析,并对术后的状况包括疼痛复发、生活质量、胰腺的影像学变化和血清胰腺酶学进行随访观察.结果 13例患者均具有典型的慢性阻塞性胰腺炎的临床表现,但12例患者的影像学表现有别于十二指肠乳突、壶腹或胰腺导管内肿瘤导致的慢性阻塞性胰腺炎的图像特征,手术探查和影像学揭示多数患者的胆胰共同通道过短或存在胰腺分裂畸形,对12例患者实施十二指肠乳突、壶腹及胰管开口切开成形术或副乳突切开成形术,术后随访结果显示均未再伴有胰腺酶学升高的急性腹痛发作.结论 以胰管扩张为主而不伴有胆管慢性梗阻是胰管开口炎性病变导致的慢性阻塞性胰腺炎的影像学特征,十二指肠乳突炎症或副乳突炎症时容易在过短的胆胰共同通道或胰腺分裂畸形的患者中引发胰管开口的狭窄而发生慢性阻塞性胰腺炎,纠正胰管开口狭窄、改善胰管引流的局部成形术是简单、有效的治疗方法.

Abstract：

Objective To explore the diagnostic methods and reasonable surgical interventions for the chronic obstructive pancreatitis due to the inflammatory lesions at the opening of the pancreatic duct Methods From January 2002 to November 2010 the data of 28 patients who were diagnosed as the chronic obstructive pancreatitis (COP) was retrospectively reviewed. Out of the 28 patients, it was analyzed that the clinical manifestations, diagnostic methods, surgical finding and surgical interventions of the 13 patients who were diagnosed as COP due to the inflammatory lesions at the opening of the pancreatic duct in the exploratory operation accompanying recurrent acute abdominal pain with increased serum amylase and lipase,dilation of entire pancreatic duct on imaging before surgery. The conditions included pain recrudescence,quality of life, pancreatic changes on imaging and the serum amylase and lipase after surgery were recorded.Results All the 13 patients had clinical manifestations of COP. However, 12 patients had different manifestations on imaging from those chronic pancreatitis imaging due to tumors at the duodenal papilla,ampulla or inner pancreatic duct. Via exploratory operation and magnetic resonance cholangiopancreatography (MRCP) , there were short pancreaticobiliary common channel or pancreas divisum existing in most patients. There was no acute abdominal pain with the increased serum amylase and lipase in the 12 patients who receiving the transduodenal mastoid, ampulla and pancreatic ductal opening incision and plasty, the paramastoideus incision and plasty in the visit Conclusions The imaging character of COP due to the inflammatory lesions at the opening of the pancreatic duct is the dilation of the pancreatic duct without the chronic obstruction in the bile duct The patients with short pancreaticobiliary common channel or pancreas divisum easily suffer COP due to the stenosis of the pancreatic ductal opening caused by the duodenal mastoiditis or paramastoiditis. The local plasty surgery to correct the stenosis at the pancreatic ductal opening and improve the drainage of the pancreatic duct is an easy and effective management.