胰管结石的分型和治疗

目的 探讨胰管结石的分型及治疗方法.方法 回顾性分析1994年6月至2009年11月湖南省人民医院收治的54例胰管结石患者的临床资料.其中Ⅰ型31例,结石位于胰头部;Ⅱ型7例,结石位于胰体尾部;Ⅲ型16例,结石分布于全胰.根据胰管结石的分型,10例患者(Ⅰ型6例、Ⅱ型2例、Ⅲ型2例)采用胰管切开取石+胰胃吻合或胰管空肠Roux-en-Y吻合术(A组),24例患者(Ⅰ型16例、Ⅲ型8例)行胰十二指肠切除术(B组),15例患者(Ⅰ型9例、Ⅲ型6例)行保留十二指肠胰头勺式切除术(C组),5例Ⅱ型患者行胰体尾+脾切除术(D组).应用t检验对所有数据进行分析.结果 A组平均手术时间(2.2±1.2)h,平均失血量(127±24)ml,术后平均住院时间(11.4±4.3)d,平均住院费用(3.24±1.15)万元;9例获随访的患者中5例结石复发.B组平均手术时间(7.6±1.1)h,平均失血量(409±37)ml,术后平均住院时间(18.9±2.5)d,平均住院费用(7.93±1.35)万元;21例获随访的患者中未见复发.C组平均手术时间(4.1±0.7)h,平均失血量(156±63)ml,平均住院时间(10.3±2.1)d,平均住院费用(4.12±1.22)万元;15例获随访的患者中无结石复发.D组平均手术时间(3.3±1.4)h,平均失血量(185±36)ml,平均住院时间(9.3±2.0)d,平均住院费用(3.22±1.05)万元,术后无并发症发生;3例获随访患者中无结石复发.胰十二指肠切除术和保留十二指肠胰头勺式切除术治疗Ⅰ、Ⅲ型胰管结石患者,在平均手术时间、平均失血量、术后平均住院时间和平均住院费用方面比较,差异有统计学意义(t=12.143,14.099,11.550,9.103,P<0.05).结论 胰管结石分型对于治疗方法的选择具有重要意义,保留十二指肠胰头勺式切除术是Ⅰ、Ⅲ型胰管结石较为理想的术式.

Classification and surgical management of pancreatic duct stones

Objective To explore the classification and surgical management of pancreatic duct stones.Methods The clinical data of 54 patients with pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 1994 to November 2009 were retrospectively analyzed. Stones were found in the head of the pancreas (type Ⅰ ) in 31 patients, in the body and tail of the pancreas (type Ⅱ ) in 7 patients, and in all the pancreas (type Ⅲ ) in 16 patients. According to the types of the pancreatic duct stones, ten patients (6 with type Ⅰ , two with type Ⅱ and two with type Ⅲ pancreatic duct stones) received opening of the main pancreatic duct + pancreaticojejunostomy or pancreaticogastrostomy ( group A). Twenty-four patients ( 16 with type Ⅰ and eight with type Ⅲ pancreatic duct stones) received pancreaticoduodenectomy (group B). Fifteen patients (nine with type Ⅰ and six with type Ⅱ pancreatic duct stones) received subtotal resection of pancreatic head preserving duodenum (group C). Five patients with type Ⅱ pancreatic duct stones received resection of the body and tail of the pancreas and the spleen (group D). All data were analyzed using the t test. Results The mean operation time, blood loss, length of postoperative stay and hospital charges of group A were (2.2 ± 1.2)hours,( 127 ±24)ml,( 11.4 ±4.3) days and (3.24 ± 1.15 ) × 104 yuan, respectively. Five out of nine patients who were followed up had stone recurrence. The mean operation time, blood loss, length of postoperative stay and hospital charges of group B were (7.6 ± 1.1 ) hours, (409 ± 37 ) ml, ( 18.9 ± 2.5 ) days and (7.93 ± 1.35 ) × 104 yuan, respectively.No stone recurrence was detected in the 21 patients who were followed up. The mean operation time, blood loss,length of postoperative stay and hospital charges of group C were (4. 1 ± 0.7 ) hours, ( 156 ± 63 ) ml, ( 10.3 ±2.1 )days and (4. 12 ± 1.22) × 104 yuan, respectively. No stone recurrence was detected in the 15 patients who were followed up. The mean operation time, blood loss, length of postoperative stay and hospital charges of group D were (3.3 ± 1.4) hours, ( 185 ± 36 ) ml, ( 9.3 ± 2.0) days and ( 3.22 ± 1.05 ) × 104 yuan, respectively. No complication was detected after the operation, and no stone recurrence was detected in the three patients who were followed up. There were significant differences in the mean operation time, blood loss, length of postoperative stay and hospital charges between patients with type Ⅰ and Ⅲ pancreatic duct stones who received pancreaticoduodenectomy and subtotal resection of pancreatic head preserving duodenum (t = 12. 143, 14. 099, 11. 550, 9. 103,P < 0.05 ). Conclusions Classification of the pancreatic duct stones is important for choosing the proper surgical procedure. Subtotal resection of pancreatic head preserving duodenum is ideal for the treatment of patients with type Ⅰ or Ⅱ pancreatic duct stones.