胰管结石的手术治疗

Surgical management of pancreatic duct stones

目的探讨胰管结石的手术治疗方式。方法对1997-2007年间24例胰管结石患者的手术治疗方式进行回顾性分析。结果24例胰管结石中行胰管纵行切开取石、胰管空肠Roux—en—Y吻合17例，其中附加主胰管外引流2例，附加胆管空肠吻合3例，附加胰腺囊肿空肠吻合1例，1例术后并发胰肠吻合口出血，1例术后早期出现应激性溃疡，均经保守治疗治愈；胰十二指肠切除3例，1例并发吻合口出血，经保守治疗治愈；胰体尾切除2例，保留十二指肠胰头切除1例，胰管切开取石、Ⅰ期缝合1例，术后均无并发症。全组21例得到随访，17例效果优良。结论胰管纵行切开取石、胰管空肠Roux—en—Y吻合是治疗胰管结石的合理术式，保留十二指肠的胰头切除和胰管切开取石、Ⅰ期缝合用于治疗胰管结石是可行的。

Objective To evaluate surgical management of pancreatic duct stones. Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis（side-to-side） of pancreatic duct to jejunum, extra drainage of the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreatic cystojejunostomy in one case. One case suffered from postoperative bleeding at pancreaticojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticoduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellent in 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.