胰管结石的诊断和治疗（附35例临床分析）

Diagnosis and treatment of pancreatolithiasis： Analysis of 35 cases

目的探讨胰管结石的诊断和治疗方法。方法回顾性分析过去10余年间治疗的35例胰管结石患者的临床资料。结果全部35例中33例出现持续性左上腹痛伴左腰背部放射痛，上腹部压痛25例。35例均行B型超声检查，诊断阳性率为88．57％（31／35）；23例行腹部CT检查，诊断阳性率为78．26％（18／23）；19例行逆行胰胆管造影检查，诊断阳性率为100％（19／19）；19例行磁共振胰胆管成像检查，诊断阳性率为94．73％（18／19）。患者分别采用手术治疗和内镜治疗。手术治疗16例，采用的术式包括胰管切开取石、胰管空肠Roux-en—Y侧侧吻合术（11例）或胰管空肠侧侧吻合、空肠空肠侧侧吻合术（3例）或胰十二指肠切除术（Child法2例），均将结石取出；内镜治疗胰管结石19例，结石均在3枚或3枚以下、局限在胰头或胰体部、直径小于1cm，取石网篮和气囊取出结石11例，放置胰管支架8例。全组无死亡病例，治疗后3周内症状都不同程度地得到缓解，随诊28例，随诊率为80％，随诊时间为1～43个月。结论胰管结石一旦诊断，均应给予积极的治疗。首选内镜治疗，内镜治疗有着严格的适应证；不适合内镜治疗并且无手术禁忌证的患者均应采取手术治疗。

Objective To evaluate the methods in diagnosis and treatment of patients with pancreatolithiasis. Methods The clinical data of 35 patients with pancreatolithiasis from January 1996 to April 2006 were retrospectively analyzed. Results There were 33 patients with persistent left upper quadrant pain, and 25 with epigastrie tenderness. Various image examinations including abdomen ultrasonography, CT scan, endoscopic retrograde cholangiopancreatography（ERCP） and magnetic resonance cholangiopancreatography（MRCP） were performed in 35, 23, 19 and 19 patients, respectively. The pancreatic duct stones were found in 31 of 35 cases（88.57 %） with ultrasonograhy, pancreatic duct dilation in 18 of 23 cases （78. 26%） with CT scan, pancreatic duct stones and dilation in 18 of 19 cases （94.73%） with MRCP, and pancreatic duet stones in 19 of 19 cases（100%） with ERCP. Sixteen patients received surgery, of which pancreatolithotomy plus side to side pancreatojejunostomy in 14 eases （Partington＇s procedure） and pancreatodudenectomy in 2 cases. The pancreatic duet stones had been suecessfully removed. Endoscopic treatment of the stones, which located in pancreatic head or body, was attempted in 19 cases. The number of stones were less than three and had a diameter of smaller than 1 era. Stones were removed successfully in 1l cases, and pancreatic duet stent were placed in 8 cases. Twenty eight patients were followed up for 1 to 43 months. Within 3 weeks after treatment, symptoms ameliorated with different degree in some patients. Conclusions Once the diagnosis of pancreatolithiasis is made, endoscopic therapy is the first choice. Surgery may have satisfactory results for the most of patients when endoscopy is not available.