胰管结石的诊治经验

Experience for diagnosis and treatment of pancreatic duct stones

目的探讨胰管结石的诊断与治疗。方法回顾性分析25例胰管结石患者的临床资料，总结诊治经验。内镜下乳头括约肌切开取石术8例，胰管切开取石、胰肠吻合术10例，十二指肠乳头成形、胰石取出术3例，胰体尾切除术2例，胰十二指肠切除术2例。结果所有患者术后7-26d出院。22例获得随访，随访时间为3个月至10年，3例失访。死亡3例。腹痛完全缓解17例，明显减轻2例，无明显效果3例。结论慢性胰腺炎、酗酒是形成胰管结石的主要原因。超声、CT、内镜逆行胰胆管造影及磁共振胰胆管造影对确定诊断有重要意义。胰管切开取石、胰肠吻合术及内镜下括约肌切开取石术是主要手术方式。

Objective To explore the diagnosis and treatment of pancreatic duct stones. Methods Clinical data of 25 cases of pancreatic duct stones were analyzed retrospectively. The experience of the diagnosis and treatment was summarized. Eight cases underwent endoscopic sphincterotomy （EST）. Ten cases did transpancreatic duct lithotomy and pancreatico - intestinal anastomosis. Three cases did sphincteroplasty. Body - tail pancreatectomy and pancreaticoduodenectomy were performed in 2 cases respectively. Results All the patients left hospital after operation 7 to 26 days. Twenty - two cases acquired follow-up, and the following-up time was 3 months to 10 years. Among the total, 3 cases were lost, 3 cases died, 17 cases abdominal pain completely relieved, 2 cases obviously mitigated and 3 cases ineffective. Conclusions Chronic pancreatitis and alcohol drinking are major causes. Ultrasonic examination, CT scan, ERCP and MRCP may establish diagnosis. EST,transpancreatic duct lithotomy plus pancreaticointestinal anastomosis are major surgery treatment.