慢性胰腺炎胰管结石的内镜介入与手术治疗

Management of pancreatic stones： endoscopy or surgery

目的探讨内镜介入及外科手术治疗慢性胰腺炎（CP）胰管结石的长期疗效。方法回顾分析1997年至2006年间在第二军医大学附属长海医院住院期间经内镜介入或外科手术治疗的疼痛性CP胰管结石病人的病历资料，随访疗效。结果入组119例，成功随访113例（95％），男：女=1．4：1，平均年龄37．4岁，平均随访时间41．8个月，内镜介入治疗组84例，外科手术组29例。内镜组与外科手术组中分别有近87％和76％病人的腹痛得到了完全或部分缓解（P〉0．05）。糖尿病和腹泻发生率在内镜治疗和手术治疗后均无显著减少，体重减轻发生率在治疗后均有好转。结论内镜介入和外科手术治疗疼痛性CP胰管结石疗效类似。

Objective To compare the long term clinical outcome of endoscopic and surgical management of painful chronic pancreatitis with pancreatic stones. Methods Patients with painful chronic pancreatitis and with pancreatic stones treated with endoscopy or surgery at our hospital were screened. The rate of technical success and complications were recorded from the charts. Follow-up data were retrospectively obtained using structured questionnaires. The main parameter for evaluating treatment success was a significant reduction in pain. Results After 12 112 months （mean 41.8 months） , follow-up data were obtained from 113 （66 males and 17 females with a mean age of 37.4 years） of 119 patients with painful chronic pancreatitis and pancreatic stones treated in our hospital. At the long-term follow-up, 52.4% of the patients receiving endotherapy （74.3%） had their extrae lion of stones completed, 36.4 % were still receiving some form of endoscopic treatment, and 25.7 had undergone surgery. Complete or partial improvement in pain was seen in about 87% of patients with endotherapy and in 76% of cases with surgery （P〉0.05）. Pancreatic function was not positively affected by endoscopic or surgical therapy. Conclusions Endotherapy and surgery can offer long-term pain relief equally in patients with painful chronic pancreatitis and pancreatic stones.