B超检查胰管结石的诊疗体会

The Diagnosis and Treatment of Pancreatic duct Stone

目的探讨胰管结石的诊治方法。方法回顾性分析本院近10年来收治的28例患者的临床资料。结果B超检查(28例):胰腺内回声不均,胰管扩张,胰管内见强光团,后伴声影(28例);大部分结石位于胰头部(24例),胰体尾结石(4)。CT检查(15例):可见胰头区增大,胰管扩张,胰头区钙化斑点(15例),胰体尾散在钙化点(4例)。ERCP检查(10例):6例胰管显影,可见胰管扩张粗细不均,胰管内有透明阴影,固定;4例胰管未显影。手术治疗(22例):胰管切开取石、胰管-空肠Roux-Y-en吻合术14例;胰管切开取石、胰管-空肠、胆总管-空肠吻合术5例;3例胰管结石合并胰腺癌的病人(术中冰冻病理检查证实为胰腺癌)分别行“胰体尾脾脏切除,胰管空肠吻合术(1例)”、“胰十二指肠切除术”(1例)和“胰腺癌扩大根治术(1例)”。患者手术后均恢复顺利。结论B超是最经济、简便、实用、有效的诊断手段,应列为首选方法。CT、ERCP检查也具有确诊价值。治疗原则是去除结石,解除胰管梗阻,建立通畅的胰液引流。手术方式以胰管切开取石、胰管(及胆总管)空肠吻合术为首选,也可根据具体情况,选择“胰体尾切除、胰管空肠吻合术,或胰十二指肠切除术”等。若取石困难,为了避免胰头组织损伤过大,不必勉强取石。

Objectives To evaluate diagnostic and therapeutic method for the pancreatic stone. Methods Clinical data of 28 patients with the pancreatic duct stone hospitalized in recent 10 years were analyzed retrospectively. Results Ultrasound examination finds pancreatic duct stone and duct dilation in all 28 patients. CT examination finds pancreatic calcification（15/15）. ERCP examination shows stone in pancreatic duct in somepatients（6/lO） and no in other ones（4/lO）.Operation treatment performed on 22 cases ： Exploration of the pancreatic duct, taking-off stone, and Roux-γ-en pancreaticojejunostomy for 14 cases; Exploration of the pancreatic duct, taking-off stone, and Roux-γ-en pancreaticojejunostomy and choledochojejunostomy for 5 cases;pancreaticojejunostomy with resection of the body-tail of the pancreas for 1 case with pancreatic cancer, pancreaticoduodenectomy for 1 case with pancreatic cancer, and extended pancreaticoduodenectomy for 1 case with pancreatic cancer. All patients recovered well. Conclusions Ultrasound examination is, of choice, the most economic, simple, valuable diagnostic method. CT/ERCP examination are ones, too. The principle of treatment is taking off stone, releasing obstruction of pancreatic duct, and drainage of pancreatic duct. The operative methods are, of choice, exploration of the pancreatic duct, taking-off stone, and Roux-γ-en pancreaticojejunostomy and choledochojejunostomy.