慢性胰腺炎伴胰头部病变的外科手术处理

目的 探讨慢性胰腺炎伴胰头病变患者的外科处理。方法 回顾性总结分析了1998年10月至2001年12月收治27例慢性胰腺炎伴胰头病变患者的临床资料。其中：保留幽门的胰十二指肠切除（PPPI手术）14例（32例慢性胰腺炎的患者术前已有门静脉栓塞），保留十二指肠胰头切除（Beger手术）2例，胰头部分切除，胰空肠侧侧吻合（Frey手术）2例，胰十二指肠切除（Whipple手术）9例，结果 2例慢性胰腺炎合并门静脉血栓的患者术前先行门静脉取栓，降低门静脉压力，然后再针对慢性胰腺炎实行外科手术，术后1例恢复顺利，另1例死于多器官脏器功能衰竭，总的院内并发症率25%，总院内死亡率4%，其中PPPD手术后院内并发症率21%，院内死亡率7%。结论 慢性胰腺炎伴胰头肿大的患者的手术治疗应根据胰腺和邻近周围其它器官的形态学改变决定手术的方法。其结果不仅可以有效地治疗慢性胰腺炎，同时有助于提高胰头癌的诊治水平。

Surgical management of chronic pancreatitis accompanied with pathological changes of pancreatic head

Objective To discuss surgical management of chronic pancreatitis accompanied with pathological changes of pancreatic head. Methods Clinical data of 27 patients who suffered from chronic pancreatitis accompanied with pathological changes of pancreatic head from October 1998 to December 2001 were reviewed. PPPD was performed in 14 patients (including two who had portal thrombosis before operation), Beger procedure in 2 patients, Frey procedure in 2 patients, and Whipple procedure in 9 patients. Results For the two patients with complicated portal thrombosis, the portal thrombosis was removed to lower portal pressure before surgical intervention for pancreatitis. One of them recovered well postoperatively and the other patient died of multi-organ failure. The overall hospital morbidity was 25% and operative mortality was 4% in all 27 patients. In the PPPD group, hospital morbidity was 21% and hospital mortality was 7%. Conclusions The surgical protocol for patients with chronic pancreatitis accompanied with enlargement of pancreatic head should be designed according to the configuration of the pancreas and conditions of other organs around it. Also, surgery should be considered when indicated, which not only offers an effective means of treatment for chronic pancreatitis but helps diagnosis of carcinoma of pancreas head.