慢性胰腺炎合并胰管结石的外科治疗

目的 探讨慢性胰腺炎合并胰管结石的外科治疗方法.方法 回顾性分析66例慢性胰腺炎合并胰管结石患者的临床资料,将其分为4型:Ⅰ型28例分布在胰头部;Ⅱ型30例在胰体部;Ⅲ型1例在胰尾部;Ⅳ型7例在胰头、胰体、胰尾部主胰管.10例(Ⅰ型4例,Ⅱ型5例,Ⅳ型1例)经镇痛、抑酸、应用生长抑素、抗感染等治疗.10例(Ⅰ型)行内镜取石术.Ⅰ型14例行胰头十二指肠切除术和保留十二指肠胰头部分切除术;Ⅱ型25例行胰管切开取石+胰管空肠吻合术;Ⅲ型1例行胰尾部+脾切除术;Ⅳ型6例行Puestow-Gillesby和胰颈部离断+胰管探查取石+胰管两断端空肠Roux-en-Y吻合术.结果 62例随访2个月至15年,Ⅰ型术后结石复发4例,Ⅱ型2例,Ⅲ型0例,Ⅳ型3例.结论 慢性胰腺炎合并胰管结石确诊后应争取早日手术治疗,根据结石分布范围选择相应的治疗方式.正确的术前及术中诊断、分型及个体化处理在预防慢性胰腺炎合并胰管结石外科治疗后结石复发中有重要意义.

Surgical management of chronic pancreatitis complicated with pancreatolithiasis

Objective To explore the surgical management of chronic pancreatitis complicated with pancreatolithiasis (CPPL). Methods The clinical data of 66 patients with CPPL were retrospectively analyzed. Pancreatolithiasis was classified into 4 types according to the location of stones: stones located in the head of the pancreas (type Ⅰ, n=28), stones located in the body of the pancreas (type Ⅱ, n=30), stones located in the tail of the pancreas (type Ⅲ, n=1) and stones located from the head to tail of the main duct of pancreas (type Ⅳ, n=7). Ten patients (including 4 with type Ⅰpancreatolithiasis, 5 with type Ⅱ and 1 with type Ⅳ) received conservative treatment; 10 patients with type Ⅰ pancreatolithiasis underwent lithotomy under endoscope; pancreaticoduodenectomy and Beger procedure were carried out on 14 patients with type Ⅰ pancreatolithiasis, pancreatolithotomy+pancreaticojejunostomy on 25 patients with type Ⅱ pancreatolithiasis, resection of pancreatic tail and spleen on 1 patient with type Ⅲ pancreatolithiasis, and Puestow-Gillesby procedure, dividing of the neck of pancreas+removing stones from both ends of pancreatic duct+Roux-en-Y pancreatojejunostomy on 6 patients with type Ⅳ pancreatolithiasis. Results Sixty-two patients were followed up for 2 months to 15 years, and the number of patients with recurrence for type Ⅰ, Ⅱ, Ⅲ and Ⅳ pancreatolithiasis was 4, 2, 0 and 3, respectively. Conclusions Early surgical management according to the location of stones should be carried out after confirmed diagnosis of CPPL. Individualized management based on correct diagnosis and classification plays an important role in the prevention of pancreatolithiasis recurrence.