慢性胰腺炎的分型与术式选择

Classification and choice of surgical procedures for chronic pancreatitis

目的 探讨慢性胰腺炎的分型与术式选择及其外科治疗效果。方法 回顾性分析我院外科 1983—2004年收治的 54例慢性胰腺炎患者的临床资料,并将其分为慢性钙化性胰腺炎及慢性梗阻性胰腺炎两组。结果 男性 41例(76% ),女性 13例(24% ),平均年龄 53 .7岁。嗜酒者 25例(46% ),合并胆石症者 21例(39% ),原因不明特发性者 2例 (4% ),既往有急性胰腺炎发作者 18例(33% )。主诉腹痛者 38例(70% ),合并黄疸者 27例(50% )。慢性钙化性胰腺炎与慢性梗阻性胰腺炎在某些临床表现间存在显著性差异,后者临床表现更趋复杂多样。34例患者分别采用 9种不同的手术方式,无围手术期死亡。Puestow手术及胰十二指肠切除可有效地缓解疼痛,并可改善胰外分泌功能,对胰内分泌的影响不大。Puestow手术并行胆肠吻合适于合并胆道狭窄的慢性胰腺炎患者;胰头肿块型胰腺炎以黄疸为主要表现,应行胰十二指肠切除等切除术式,仅行胆道引流减黄效果良好,但胰头病变的演变尚待进一步观察。结论 慢性梗阻性胰腺炎临床表现复杂,外科治疗应采用个体化原则。

Objective To explore the classification, choice of surgical procedures and the clinical outcome of surgical management for chronic pancreatitis. Methods 54 patients with chronic pancreatitis undergoing operation in our hospital from 1983 to 2004 were analyzed retrospectively, who were divided into chronic calcifying pancreatitis and chronic obstructive pancreatitis according to the clinical manifestations. Results There were 41 men (76%) and 13 women (24%) with a mean age of 54 years. The cause of chronic pancreatitis was alcohol related in 25 cases (46%), cholelithiasis in 21 (39%), and previous episodes of acute pancreatitis in 18(33%). Clinical manifestations included abdominal pain in 38 cases (70%), obstructive jaundice in 27 cases (50%). There existed a significant difference in some clinical materials between the two groups of chronic calcifying pancreatitis and chronic obstructive pancreatitis, which might mean the different pathologic basis in the two kinds of chronic pancreatitis. A total of 34 patients underwent nine different operations without perioperative deaths. Both the Puestow procedure and the pancreatoduodenectomy was safe and achieved pain relief in a large percentage of patients, which could also improve the exocrine function whereas the endocrine function remained unchanged. Addition of biliary bypass to the Puestow procedure was suitable for the patients with stenosis of common bile duct. Jaundice was the main manifestation in the patients with the inflammatory mass in the head of the pancreas and Whipple′s procedure or other resectional procedures should be performed for them. Only drainage of bile duct had a better outcome for the relief of jaundice, but its effect to pancreas need to be further evaluated. Conclusion The clinicopathologic characteristics of obstructive chronic pancreatitis was more variable and the surgical management should be also different for individuals.