胰管结石伴发慢性胰腺炎急性发作临床诊治探讨

Diagnosis and treatment of pancreatic duct stones companying acute occurrence of chronic pancreatitis

目的探讨胰管结石伴发慢性胰腺炎急性发作的临床治疗方案。方法回顾性分析南华大学附属南华医院1998年1月至2006年9月收治的11例胰管结石伴发慢性胰腺炎急性发作病人的临床资料，11例均接受手术治疗，其中胰头部胰管切开加十二指肠乳头成形及胆总管切开T管引流术2例，胰管切开取石并胰管空肠Roux-enY吻合术5例，胰体尾切除加胰断端面胰管空肠Rouxen-Y吻合2例，单纯胰尾切除2例。结果术后疼痛治愈率54．54％（6／11），好转率45．45％（5／11），胰漏（瘘）或出血27．27％（3／11）。9例平均随访时间（39．2±36．2）个月，均无并发症出现。结论胰管结石伴发慢性胰腺炎急性发作者早期宜非手术治疗，3个月后接受适宜的外科手术治疗，效果肯定，并发症发生率较低，术式根据结石部位、主胰管是否通畅决定。

Objective To explore the therapeutic scheme of pancreatic duct stones companying acute occurrence of chronic pancreatitis. Methods A total of 11 cases of pancreatic duct stones companying acute occurrence of chronic pancreatitis were surgically treated in our hospital from January 1998 to September 2006. Of the 11 patients, 2 were subjected to pancreatico-lithotomy, duodenal pap- illotomy and hepatocholangiostomy, 5 to pancreatico-lithotomy and pancreaticojejunostomy, 2 to resection of pancreatic tail with pancreaticojejunostomy and the other 2 to single resection of pancreatic tail. Results In general, the initial symptom of pancreatic duct stones companying acute occurrence of chronic pancreatitis was characterized by acute upper abdominal pain. B-mode uhrasonography and CT were important for its early diagnosis and ERCP was also of help to diagnosis. After operation, chron- ic abdominal pain disappeared in 54.54 % （6/11） and ameliorated in 45.45 % （ 5/11 ）. Pancreatic fistula or bleeding occurred in 27.27% （3/11） of the patients. The follow-up of a mean of（39.2 ±36.2） months in 9 patients showed that there was no complication. Conclusion Pancreatic duct stones companying acute occurrence of chronic pancreatitis should be managed by conservative treatment in the early phase of disease, and correlative operation 3 months later.