从病理解剖学探讨慢性胰腺炎手术治疗的合理性

目的 探讨病理解剖学改变对慢性胰腺炎手术方式选择的指导意义，评价外科治疗的远近期效果，为设计合理化手术方案提供临床依据。方法 回顾性研究北京大学第一医院2000-2010年外科治疗60例慢性胰腺炎病人的临床资料。结果 围手术期死亡1例（1.7%）。60例慢性胰腺炎病人合并腹痛43例（71.7%），42例手术后疼痛获缓解，远期复发17例（40.5％）。合并胰管扩张和（或）胰管结石行改良Puestow术21例，远期复发8例（38.1%）；6例行不同范围胰头切除术者未见症状复发，11例仅行胆肠吻合者2年内疼痛复发9例（81.2%）。合并胆道梗阻者33例（55%），单纯或联合其他手术的胆肠吻合均能缓解黄疸，单纯胆肠吻合后33.3%（4/12）新发腹痛，5例胰头切除术后病人长期随访无黄疸和腹痛复发。结论 根据慢性胰腺炎病理解剖学改变选择具针对性手术效果良好，合理的切除加充分的胰胆引流可显著改善临床症状。

Rationality of surgical managements according to the pathological anatomy of chronic pancreatitis

Objective To investigate the outcome after surgery directed by pathological anatomy of chronic pancreatitis and provide evidence for surgical procedures. Methods The clinical material of 60 patients with chronic pancreatitis who underwent surgical treatment between 2000 and 2010 were investigated retrospectively. Result 43 cases (71.7%) presented with abdominal pain, Perioperative mortality was 1.7% (1 case). Forty-two patients with abdominal pain were all relieved after surgery, but long-term recurrence oc...