慢性胰腺炎致梗阻性黄疸的外科治疗方式与合理性分析

目的探讨慢性胰腺炎所致梗阻性黄疸的外科治疗及其合理性.方法回顾性研究我院1985年1月至2004年12月20例慢性胰腺炎伴非结石性梗阻性黄疸的临床特点及诊治措施.结果（1）本组病例主诉黄疸,90.0%无典型慢性胰腺炎临床表现及影像特征,胰内段胆总管狭窄是特征性影像表现;（2）本组病理诊断为弥漫性胰腺慢性炎症,并造成胰内段胆总管狭窄;（3）本组选择Oddi括约肌成形术（2例）或胆肠吻合术（18例）,胆道引流效果稳定;（4）单纯T管引流者无法撤除引流管.结论本研究关注慢性胰腺炎病例中伴胆道梗阻,但缺乏典型临床及影像表现者,占同期住院慢性胰腺炎的15.0%;其伴发梗阻性黄疸与胰腺炎症直接相关;胆道引流术可缓解梗阻,胆囊或胆总管空肠吻合是安全、经济的治疗措施;单纯T管引流不是理想的选择;无胰管病变及慢性胰腺炎其他症状时无须针对胰腺进行手术操作.

Selection of surgical treatments and analysis of its reasonableness for chronic pancreatitis with obstructive jaundice

Objective To discuss the selection of surgical treatments and analyze its reasonable- ness for chronic pancreatitis resulting in obstructive jaundice.Methods The clinical data of 20 pa- tients with chronic pancreatitis resulting in obstructive jaundice treated in our hospital from January 1985 to December 2004 were retrospectively analyzed.Results 1)The main cause for admission was icterus.Ninety percent of the patients did not have the clinical manifestations and radiological features of the chronic pancreatitis.The major radiological feature was the stricture of intra pancreatic common bile duct.2)Pathological examination showed that there were inflammation and fibrosis that resulted in the stricture of the intra-pancreatic common bile duct.3)Sphincterplasty was performed in 2 pa- tients and anastomosis between the biliary system and enteron in the other 18.Stable results were ob- rained after biliary drainage.4)The drainage tube could not be withdrawn from the patients receiving simple drainage procedure with T-tube.Conclusions The patients in this study account for 15.0% of all the inpatients with chronic pancreatitis.The presentation of jaundice is associated with obstruction of the common bile duct.The jaundice and obstruction of the common bile duct are due to chronic in- flammation and fibrosis of the pancreas.Biliary drainage can he used to alleviate the obstruction and jaundice.Cholecystojejunostomy or choledochojejunostomy is safe.economical and effective for this disease.The drainage using T-tube is not a reasonable procedure.No drainage procedure for pancreat- ic duct is necessary if there exists no disease affecting the structure of the main duct.