胰管结石的治疗:附37例报告

The management of pancreatolithiasis:a report of 37 cases

目的探讨胰管结石的外科处理方法。方法回顾性分析近13年我院收治的37例胰管结石临床资料。结果将胰管结石分为3型：I型，结石主要位于胰头部，以采用胰头十二指肠切除为主；Ⅱ型，结石主要位于胰体尾部，以采用胰尾部或加脾切除为主；Ⅲ型，结石广泛分布于头、体和尾部，主要采用胰头切除，大口径胰管切开取石加胰管空肠Roux—en—Y吻合术。全组病例无死亡。治疗后2周内症状不同程度缓解。随诊31例（83．8％），随诊时间为6～72个月，效果满意。结论在胰管结石治疗中应根据胰管结石的类型采用不同的手术方式，其外科治疗关键是清除胰石、切除病胰、通畅引流。

Objective To study the surgical treatment of pancreatolithiasis. Methods The clinical data of thirty-seven patients with pancreatolithiasis admitted to our hospital from 1994 to 2007 were reviewed. Results According to the results of imaging examination （ BUS, CT, ERCP ） and finding during surgery, pancreatolithiasis was classified into three types： Type I , the stones were mainly located in the head of pancreas, and Whipple procedure was the treatment of choice. Type Ⅱ , the stones were mainly located in the body and tail of pancreas, and resection of the tail of pancreas alone or combined with splenectomy was the management of choice. Type Ⅲ , the stones were diffusely scattered in the main duct from the head to tail of pancreas, and pancreatoduodenectomy, together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. There was no mortality in this series. Within 2 weeks after treatment, symptoms ameliorated to different degrees in all the patients. Thirty one patients were followed up for 6 to 72 months, the results were satisfactory. Conclusions The individualized strategy, based on the type of stone location, is of great importance in the management of pancreatolithiasis. The key of surgical treatment of pancreatolithiasis is as follows： removal of pancreatoliths, excision of diseased pancreas, and adequate pancreatic drainage.