慢性胰腺炎胰管多发结石手术治疗临床分析（附17例报告）

目的 探讨慢性胰腺炎胰管多发结石的手术治疗方法及效果.方法 回顾性分析2000年1月至2013年12月14年间经手术治疗的17例慢性胰腺炎胰管多发结石病人的临床资料.其中3例胰头肿块合并胰头部胰管结石,5例胰体结石,8例胰尾结石,1例全胰管结石.结石数量4～31枚.2例行胰十二指肠切除术,10例行胰管空肠Roux-y吻合术,5例行胰尾切除术.其中4例同时行脾切除术.结果 17例均完成手术,无手术死亡及胰漏.术后出现胸腔积液2例,切口裂开1例.获随访13例,时间1～7年,复查CT,1例胰体结石复发.术前腹痛12例术后8例（66.7％）疼痛完全消失,3例疼痛部分缓解,1例术后未戒酒,慢性胰腺炎未控制,顽固性疼痛需止痛药物治疗.术前血糖升高10例,术后8例血糖恢复正常,2例仍需胰岛素控制.术前脂肪泻6例,有4例痊愈,2例仍服胰酶制剂.结论 外科手术是治疗多发胰管结石的有效方法.

Management of chronic pancreatitis with pancreatic duct stones: a report of 17 cases

Objective To evaluate the efficacies and operative approaches in the treatment of chronic pancreatitis with pancreatic duct stones.Methods Retrospective analyses were conducted for the clinical data of 17 surgical cases of multiple calculi in patients with chronic pancreatitis and pancreatic duct during January 2000 to December 2013.There were pancreatic head mass with pancreatic head stone （n =3）,pancreatic calculi （n =5）,pancreatic tail stones （n =8）,1 case of pancreatic duct stones （n =1）.The number of stones was 4 to 31.The procedures included pancreatoduodenectomy （n =2）,10 cases of pancreas-to-jejunal Roux-y anastomosis （n =10） and pancreatic tail resection （n =5）.There were 4 cases of concurrent splenectomy.Results There was neither operative mortality nor pancreatic leakage.The postoperative complications included pleural effusion （n =2） and wound dehiscence （n =1）.And 13 cases were followed up for 1-7 years.On computed tomography （CT） re-examination,1 case had pancreatic stone recurrence.Among 12 cases of preoperative abdominal pain,there were complete relief （n =8）,partial relief （n =3） and non-relief （n =1）.Among 10 cases of preoperative hyperglycemia,postoperative blood glucose returned to normal （n =8） and insulin was required （n =2）.Among 6 cases of preoperative fatty diarrhea,4 were cured while another 2 required pancreatin.Conclusions Surgery is efficacious for multiple pancreatic duct stones.