慢性胰腺炎伴胰管结石外科治疗体会

目的 探讨慢性胰腺炎伴胰管结石外科治疗的术式选择.方法 对1991年6月至2006年6月收治的17例慢性胰腺炎伴胰管结石手术治疗的患者进行回顾性分析,总结不同类型的胰管结石的手术方式及结果.结果 本组17例中胰头部胰管结石13例,胰体尾部胰管结石4例,合并胆石症6例,其中6例行胰管切开取石胰管空肠吻合术(Partington法);4例行胰管胃吻合术(Warren法);3例行保留十二指肠胰头次全切除术(Beger法);3例行胰尾切除胰腺空肠吻合术(Duval法);1例行胰尾、脾切除胰腺空肠吻合术.17例临床治愈,其中上腹部顽固性疼痛完全缓解15例,血糖控制2例,胰漏2例,1例术后11个月死于胰腺癌.结论 针对慢性胰腺炎合并胰管结石患者的不同状况采取的手术方式应高度个体化,有主胰管扩张者采取引流术,无胰管扩张及局部胰腺病变者采取胰腺部分切除联合内引流术,同时注意尽量保存胰腺组织功能,可明显改善患者生活质量.

Surgical procedures for chronic pancreatitis associated with pancreatic duct stones

Objective To investigate the surgical procedures for chronic pancreatitis associated with pancreatic duct stones.Methods The clinical data of 17 cases of chronic pancreatitis with pancreatic duct stones surgically treated were analyzed retrospectively.Results Of the 17 cases,13 had pancreatic duct stones in the head of the pancreas.4 had pancreaticolithiasis in the body and tail of the pancreas,six had additional choledocholithiasis.Surgical treatments included Roux-en-Y anastomosis of the pancreatic duct and jejunum in 6 cases(Partington procedure),anastomosis of pancreatic duct and stomach in 4 cases (Warren procedure).subtotal resection of the head of the pancreas with duodenal preservation in 3 cases (Beger's procedure).removal of the tail of pancreas with Roux-en-Y anastomosis of the distal pancreatic end to the iejunum in 3 cases(Duval's procedure),removal of the tail of pancreas and spleen with a Roux-en-Y anastomosis of the distal pancreatic end to ieiunum in 1 case.All 17 patients were cured,with complete relief of intractable abdominal pain in 15 cases.blood glucose was under eontrol in two out of six diabetics.Two cases suffered from postoperative pancreatic fistula.one patient died of pancreatic cancer 11 months after operation.Conclusion For patients with chronic pancreatitis and pancreaticolithiasis.surgical treatment should be highly individualized.We suggest drainage procedures for patients with dilatation of the pancreatic duct.Patients with no dilatation of the pancreatic duct and those with suspected carcinoma can be treated by partial pancreatectomy and Roux-en-Y pancreaticojejunostomy.Meanwhile effort must be applied to preserve the exocnne and endocrine pancreatic function vital for the patient's quality of life.