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.

The Surigical Indications and Procedures of Chronic Pancreatitis

Objective To improve the effects of surgical treatment in chronic pancreatitis. Methods 55 cases of chronic pancreatitis were retrospectively analyzed. The following characters were related to chronic pancreatitis:heavy drinking for 5 years (38.2%), calculi in biliary system(29.1%) and history of acute pancreatitis (20.0%). The patients were complicated with the following symptoms and diseases:chronic abdominal pain(98.2%), obstructive jaundice(38.2%), body weight losing more than 3 kg(34.5%), maldigestion (20.0%) and diabetes (10.9%). 10 different procedures were performed because of chronic abdominal pain, obstruction of pancreatic ducts or common bile ducts, pancreatic calcification, pancreatic duct calculi, and pseudocyst, et al. Result No patient died, nor severe complications occurred. 43 cases(78.2%) achieved good effects, 10 cases(18.2%) got improved, but 2 cases(3.6%) failed. Conclusion Surgical indications for chronic pancreatitis were chronic abdominal pain, pancreatic ductal obstruction, common bile ductal obstruction, pancreatic calcification and pseudcysts. Operative procedures should be choosed according to different pathological characters and clinical menifestations. Pancreatico-jejunostomy or pseudocyst jejunostomy should be performed for dilation,calculi or obstruction in pancreatic duct or pancreatic pseudocyst. Head pancreatectomy or cholangio-pancreatico-jejunostomy should be performed for pancreatic head tumor with obstruction in pancreatic ducts or common bile ducts.