胰管结石的诊断与外科治疗：附43例报告

目的:探讨胰管结石的诊断及手术治疗方式。方法:回顾性分析6年间进行外科手术的43例胰管结石患者的临床资料。结果:患者男女比例约为2:1,主要症状为上腹痛,部分伴腰背痛。全组均采用影像学检查方法确诊。行胰管切开取石、胰管空肠侧侧Roux-en-Y吻合术34例(其中同时切除胰体尾2例),保留十二指肠的胰头切除术5例,保留幽门的胰十二指肠切除1例,胰十二指肠切除术1例,胰体尾、脾切除1例,探查发现恶变无法切除1例。随访5个月至6年;43例患者中23例腹痛症状完全缓解,18例有不同程度的缓解。结论:影像学检查是确诊胰管结石的主要方法。对胰管结石的手术应制定个体化方案。胰管切开取石,胰管-空肠Roux-en-Y吻合术为胰管结石的主要术式,其他可根据情况采用保留十二指肠的胰头切除术或胰体尾切除等术式。

Diagnosis and surgical management of pancreatic duct stones: a report of 43 cases

Objective: To investigate the diagnosis and surgical treatment of pancreatic duct stones. Methods: The clinical data of 43 patients undergoing surgical procedure for pancreatic duct stones during the past 6 years in our hospital were retrospectively analyzed. Results: The male-to-female ratio among the patients was 2:1.The main symptom of the patients was upper abdominal pain and some of them had accompanied lower back pain.The diagnosis of all cases was confirmed by imaging examinations.Thirty-four cases underwent pancreatic lithotomy with a side-to-side Roux-en-Y pancreaticojejunostomy(two cases had a synchronous resection of the body and tail of the pancreas),five cases underwent duodenum-preserving pancreatic head resection,and pylorus-preserving pancreaticoduodenectomy,classical Whipple procedure and resection of the body and tail of the pancreas with splenectomy were performed in one case each,respectively,and unresectable tumor was found in one case during surgical exploration.The period of follow-up ranged from 5 months to 6 years.Of the 43 patients,23 cases had their abdominal pain completely alleviated and 18 cases had varying degrees of improvement. Conclusion: Imaging examination is the main modality for diagnosis of pancreatic duct stones,and the surgical procedure for this condition should be individualized to the specific patient.Pancreatic lithotomy with a side-to-side Roux-en-Y pancreaticojejunostomy is the main operative procedure for pancreatic duct stones,and other procedures such as duodenum-preserving pancreatic head resection or distal pancreatectomy may be recommended depending on the patient’s situation.