胰管结石的诊断与治疗

Diagnosis and treatment of pancreatic duct stone

目的探讨胰管结石的诊断方法及如何选择合理的治疗方式。方法对2005年3月至2009年8月收治的16例胰管结石患者的临床资料进行回顾性分析。结果15例患者以不同程度的上腹痛就诊，1例以不规则腹泻就诊。血、尿淀粉酶高于正常值上限3例，血糖升高4例。B超、CT、MRI、ERCP和腹部平片的诊断率分别为93．8％（15／16）、68．8％（11／16）、57．1％（4／7）、100％（2／2）和50％（3／6）。治疗方式包括内镜下胰管括约肌切开取石＋胰管支架引流术2例，胰管切开取石、胰管空肠Roux—en。Y吻合术12例，胰十二指肠切除术1例，胰体尾切除＋胰管空肠Roux—en—Y吻合术1例。全组无手术死亡病例：治疗后腹痛症状均有明显改善。随访14例，无结石复发，失访2例，随访率为87．5％，随访时间为1～53个月。结论胰管结石首选B超检查，多种影像技术的联合应用可明显提高诊断率。全面的影像学检查是判断选择内镜治疗抑或是手术治疗的重要依据。随着内镜治疗技术的逐步成熟，ERCP将与外科手术一样成为胰管结石重要的治疗手段。

Objective To explore the methods of diagnosis and appropriate treatment of pancreatic duct stone. Methods Clinical data of 16 patients with pancreatic duct stone from March, 2005 to August, 2009 were analyzed retrospectively. Results 15 patients presented with varying degrees of upper abdominal pain, another one with irregular diarrhea. Serum and urine amylase level was higher than the upper limit of normal level in 3 patients; serum glucose was elevated in 4 patients. The diagnostic accuracy by Buhrasonography, CT, MRI, ERCP and KUB was 93.8% （ 15/16）, 68.8% （ 11/16）, 57.1% （4/7） ; 100% （2/2） and 50% （3/6）, respectively. 2 cases underwent endoscopic pancreatic sphincterotomy ＋ pancreatic stent drainage, 14 cases were treated with surgery, including transpancreatic duct lithotomy ＋ pancreatic jejunal anastomosis in 12 cases, pancreatoduodenectomy in 1 case, and pancreatic body and tail resection ＋ pancreatic jejunal Roux-en-Y anastomosis in one case. All operations were successful without mortality, and abdominal pain was significantly improved. Follow up of 14 cases showed no stone recurrence. Two patients were lost in follow up, so the follow up rate was 87.5% with the duration ranging from 1 to 53 months. Conclusions B-ultrasonography was the best imaging examination for pancreatic duct stone, but the combined application of imaging tests could significantly improve the diagnostic yield, and imaging examination provided an important basis for the choice of treatment method. With the improvement of endoscopic techniques, ERCP will be as important as surgery for the treatment of pancreatic duct stone.