摘要
目的探讨胰管结石的诊断及外科处理方法。方法对1990年7月～2009年11月收治的38例胰管结石的临床资料进行回顾性分析。结果患者均缺乏特异性症状,主要系上腹部疼痛伴(或不伴)肩背部放射痛入院。全组均采用影像学检查方法(B超,腹部X线平片,腹部CT,内镜逆行胰胆管造影,磁共振胰胆管造影)确诊。19例行胰管切开取石、胰管空肠侧侧Roux-en-Y吻合术,1例行胰十二指肠切除术,1例行胰体尾、脾切除+胰管取石+胃-空肠吻合术,14例行保守治疗;3例自动出院。随访6月至1年;21例行手术治疗者其中14例腹痛症状消失,余均有不同程度缓解。14例保守治疗者其中7例腹痛症状消失,5例缓解,2例未缓解。6例合并糖尿病者术后血糖控制平稳。3例合并脂肪泻者症状均消失。结论影像学检查是确诊胰管结石的主要方法。手术治疗是胰管结石的主要治疗方法,其中以胰管切开取石,胰管-空肠Roux-en-Y吻合术为胰管结石的主要术式,合并胰头癌者应行胰十二指肠切除术。
Objective To sum up the experience in the diagnosis and treatment of pancreatic duct stones.Methods The clinical date of 38 patients treated in our hospital form 1990～2009 were retrospectively analyzed.Results Patients were all lack of specificity symptoms.Major for abdominal pain with （or without） humeral back radiation pain to the hospital.The diagnosis of all cases was confirmed by imaging examinations such as B ultrasonography,abdominal X-ray film,CT,endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography）.The operative methods were pancreatolithotomy with Roux-en-Y side-to-side pancreaticojejunostomy in 19 cases,pancreticoduedenectomy in 1case,distal pancreatectomy with splenectomy in 1 case;14 received conservative treatment.Discharged Patients are 3.All the cases were followed up from 6 months to 1 year.Among 21 cases with Surgical treatment,the abdominal pain disappeared in 14 cases,and other are alleviated in different degree.Among 14 cases with conservative treatment,the abdominal pain disappeared in 7 cases,alleviated in 5 cases,and unalleviated in 2 cases.Among 6 cases with diabetes mellitus before operation,blood glucose all control the smooth postoperatively.3 cases with steatorrhea before operation,the steatorrhea all disappeared.Conclusions Imaging examinations are the main methods for diagnosis of pancreatic duct stones.Surgical treatment is the main treatment on pancreatic duct stones.The main operative method is pancreatolithotomy with Roux-en-y side-to-side pancreaticojejunostomy,and Pancreatic head carcinoma should do pancreticoduedenectomy.
出处
《肝胆外科杂志》
2010年第4期267-270,共4页
Journal of Hepatobiliary Surgery
关键词
胰管结石
诊断
治疗
pancreatic duct stones
diagnosis
treatment
