胰管结石外科治疗术式探讨

Surgical procedures for pancreatic duct stone

目的探讨胰管结石外科治疗的术式选择。方法对7例胰管结石患者进行手术治疗。采用胆管、胰管空肠(侧侧)Roux-Y吻合术+胆囊切除、胆管探查、T管引流术4例,采用胰管切开取石、胰管空肠(侧侧)Roux-Y吻合术+胆管探查、T管引流术1例,采用保留十二指肠的胰头切除、尾侧胰腺断端空肠(端侧)Roux-Y吻合术+胆囊切除及胆总管探查取石、T管引流术1例,采用胰十二指肠切除术1例。结果7例均痊愈,其中1例术前并发上消化道大出血,误切第一组小肠,遗有短肠综合征;另1例生存至1.5年后发生胰腺癌变死亡。结论外科手术仍是本病主要的治疗方法,主要有引流术和胰腺部分切除术,有主胰管扩张者宜采用引流术,无胰管扩张和胰腺病变局限化者,可用胰腺部分切除术,再联合内引流术;依据胰腺病变的具体情况选择最佳术式,手术疗效满意。

Objective To evaluate the surgical procedures of pancreatic duct stone. Methods Seven cases of pancreatic duct stone were subjected to surgical treatments, including Roux - Y anastomosis （side- to- side） of bile duct to pancreatic duct and jejunum plus cystectomy, exploration of bile duct and T - tube drainage in 4 cases, lithotomy by pancreatic incision, Roux - Y anastomosis （side - to- side） of pancreatic duct to jejunum plus bile duct exploration and T - tube drainage in one case, removal of head of pancreas with duodenum preserved and Roux - Y anastomosis （end - to - side） of caudal pancreatic breaking end to jejunum plus cystectomy, exploration and lithotomy of common bile duct and T - tube drainage in one case, and duodenectomy in one case. Results All the 7 patients in our group were cured. One patient had gastrointestinal bleeding preoperatively and his first group of intestine was dissected in the procedure of treatment. The patient experienced short gut syndrome postoperatively. One patient died of pancreatic tumor one and a half years after the operation. Conclusion Surgical procedure is still primary treatment method for pancreatic duct stone, including drainage and partial pancreatectomy. We generally suggest to perform drainage procedure for patients with extension of pancreatic duct. The patients, who had no duct extension and pancreatic pathological changes, can be treated by partial pancreatectomy and pancreatic duct - ileostomy.