摘要
目的总结慢性胰腺炎外科手术方式的选择以及治疗效果的评价。方法回顾分析2002年10月至2011年10月24例北京友谊医院以慢性胰腺炎行外科手术治疗的24例患者资料。结果24例患者术前均诊断为慢性胰腺炎，其中22例术中及术后病理证实为慢性胰腺炎，2例根据术中所见及术后病理结果证实为慢性胰腺炎癌变；临床表现包括上腹痛24例，梗阻性黄疸4例，十二指肠梗阻1例，门静脉高压症伴腹腔积液2例，脂肪泻1例，继发性糖尿病者5例；有单纯酗酒史者9例，有单纯胆石症病史者4例，酗酒合并胆石症病史者5例，特发型慢性胰腺炎6例。手术方式包括胰十二指肠切除术（Whipple手术）6例，保留十二指肠的胰头切除加胰肠侧侧吻合术（Frey手术）1例，改良Frey手术（Izbicki手术）1例，胰管纵行切开减压胰肠侧侧吻合术加空肠侧侧吻合术（改良Partington—Rochelle手术）15例，胰体尾及脾切除术1例。无手术死亡病例，术后并发症有胆漏1例。患者均获得随访，随访时间7个月至9年，无一例发现癌变，腹痛复发同术前者4例。结论对于慢性胰腺炎患者，建议根据其临床分型选择手术方式；胰头肿块型慢性胰腺炎应积椰丰术治疗：术后府茵励戒酒。
Objective To summarize the choices of surgical operation modes and the evaluation of thera- peutic effect on chronic pancreatitis. Methods The clinical data of 24 cases of chronic pancreatitis undergoing sur- gical operations were retrospectively analyzed in Beijing friendship hospital from October 2002 to October 2011. Re- suits All 24 cases were all diagnosed of chronic pancreatitis before operation. 22 cases were identified of chronic pancreatitis according to the findings of operation and postoperative pathology; the other 2 cases were identified of chronic pancreatitis canceration according to the findings of operation and postoperative pathology. The symptom in- cluded abdominal pain （24 cases）, obstructive jaundice （4 cases）, obstruction of duodenum （1 case）, portal hy- pertension complicated ascites （1 case）, steatorrhea （1 case） and diabetes mellitus （5 cases）. The histories in- cluded alcohol abuse only （9 cases）, cholelithiases only （4 cases）, alcohol abuse combined with cholelithiases （5 cases） and idiopathic （6 cases）. The operation modes included pancreaticoduodenectomy （Whipple） 6 cases, duodenum-preserving pancreatic head resection and pancreaticojejunostomy （Frey procedure） 1 case, modified Frey procedure （ Izbicki procedure） 1 case, longitudinal pancreaticojejunostomy and jejunum anastomosis （ modified Par- tington-Rochelle procedure） 15 cases, distal pancreatectomy and splenectomy 1 case. There was no operative death. Postoperationg complications included biliary leakage （ 1 case）. All patients got postoperation follow-up, ranging from 7 months to 9 years. None was found canceration of chronic pancreatitis. 4 cases had abdominal pain recur- rence. Conclusions Tthe most suitable surgery procedure of chronic pancreatitis should be chosen according to clinical types. Surgical procedure should be suggested in patients of chronic pancreatitis with mass in the head of pancreas. Giving up alcohol should be encouraged after operation.
出处
《中国医药》
2013年第7期953-955,共3页
China Medicine
关键词
慢性胰腺炎
手术方式
胰十二指肠切除术
Chronic pancreatitis
Surgery procedure
Pancreaticoduodenectomy
