慢性胰腺炎的病理类型和手术术式的选择

Operative mode based on clinicopathologic features in patients with chronic pancreatitis

目的探讨慢性胰腺炎的病理形态改变和根据病理形态选择外科手术术式的合理性。方法对最近9年收治并行手术治疗的40例慢性胰腺炎的病理形态类型和手术术式进行回顾性分析。结果胰管纵行切开减压胰肠侧侧吻合术的疼痛缓解率为79%,排除胰头炎性增大和合并十二指肠降段胰内憩室的病例,疼痛缓解率为86%。常规或保留幽门的胰十二指肠切除或(和)保留十二指肠的胰头切除术有良好的疼痛缓解作用,但术后有22%的糖尿病发生率。结论胰管纵行切开减压胰肠侧侧吻合术简单安全,适用于最常见的胰腺纤维化萎缩、胰管扩张伴有结石的病例。伴有胰头局部性炎性包块、胰腺纤维性增生和导管上皮增生为主要表现的病例以及合并十二指肠降段胰内憩室的病例不适宜行胰管纵行切开减压胰肠侧侧吻合术,应选择各类胰头切除术。

Objective To classify chronic pancreatitis （CP） based on pathological features and evaluate the benefits of different surgical procedures according to the pathological forms. Methods Forty CP cases during recent 9 years who underwent surgical therapy were retrospectively reviewed in association with clinicopathological analysis. Results Postoperative pain-relief rate was 79. 16% in patients treated with longitudinal pancreaticojejunostomy（LPJ）. In cases without enlarged pancreatic head or diverticulum of duodenum, postoperative pain-relief rate was 86%. Postoperative pain-relief rate was high by Whipple＇s procedure, pylorus-preserving pancreaticoduodenectomy or Beger duodenum-preserving pancreatic head resection,while postoperative diabetes mellitus developed in 22%. Conclusions Both pathological form and operative procedure were factors influencing outcomes of CP. LPJ is still a main surgery for most CP patients with pancreatic fibrosis and dilated pancreatic duct and pancreatic stone. Some patients of CP with enlarged pancreatic head, hyperplasia of pancreatic parenchyma and pancreatic duct epithelia or complicated with diverticulum of the duodenum should be treated with resections targeting at the head of the pancreas.