保留十二指肠的胰头全切术治疗慢性胰腺炎35例报告

Duodenum-preserving total pancreatic head resection for chronic pancreatitis： a report of 35 cases

目的总结保留十二指肠的胰头全切术治疗慢性胰腺炎的经验。方法回顾分析自1999年1月至2006年12月采用保留十二指肠的胰头全切术治疗慢性胰腺炎35例的临床资料，并对患者疼痛改善情况及内分泌功能变化进行随访。结果平均手术时间为286±55min，平均手术输血量为1.4±1.3单位压积红细胞。无手术死亡。术后并发症发生率为17％，其中1例胰瘘，3例胆漏，1例腹腔出血，1例切口裂开，无十二指肠瘘。术后患者疼痛得到缓解，QLQ-C30疼痛评分由术前的59±27降至术后的13±21。术后患者内分泌功能未继续恶化，随访过程中无新增糖尿病病例出现。结论保留十二指肠的胰头全切术是一种安全、有效的治疗慢性胰腺炎的手术方式。较之保留十二指肠的胰头次全切除术，本手术能更彻底的切除胰头和钩突的炎性病变。

Objective To evaluate a duodenum-preserving total pancreatic head resection procedure for the treatment of chronic pancreatitis in patients with a pain-inducing enlarged pancreatic head. Methods From January 1999 to December 2006, 35 cases underwent duodenum-preserving total pancreatic head resection procedure without segment resection of the duodenum, as a modified Beger＇s procedure. Pain scale in the EORTC QLQ-C30 questionnaire was used to estimate the effect of the surgical procedure on pain relief, and oral glucose tolerance test （OGTF） was used to estimate the maintenance of endocrine function. Results For the anastomosis of the distal pancreas and the jejunum, end-to-end invagination anastomosis was performed in 21 cases, end-to-side duct to mucosa anastomosis was performed in 10 cases, and side-to- side duct drainage procedure was performed in 4 cases. Additional T-tube drainage of the common bile duct was adopted in 4 cases for a possible injury of the common bile duct, and anastomosis of the common bile duct and the duodenum was performed in 1 case for common bile duct obstruction. The mean operation time was 286±55min, and the mean red blood cell （RBC） transfusion was 1.4±1.3units. The mean hospital stay was 13±4days. The mortality of the surgical procedure was 0. The overall morbidity was 17%. Pancreatic fistula developed in 1 case, bile leakage in 3 cases, wound disruption in 1 case, intraabdominal bleeding in 1 case, and there was no duodenal fistula. After the surgery, the mean EORTC QLQ-C30 pain scale decreased from 59±27 to 13±21. On follow-up the endocrine function remained stable, and no new case of diabetes was found. Conclusion The duodenum-preserving total pancreatic head resection procedure without segment resection of the duodenum has good postoperative outcomes, and benefits extirpation of inflammatory pancreatic lesions of the head and uncinate process. It is a safe and effective surgical procedure for chronic pancreatitis with an enlarged and painful pancreatic head.