保留十二指肠胰头切除术治疗慢性胰腺炎的疗效观察

Duodenum-preserving pancreatic head resection in treating patients with chronic pancreatitis

目的 探讨保留十二指肠胰头切除术治疗慢性胰腺炎（CP）的临床疗效.方法 2004年2月至2010年3月河南省人民医院肝胆胰腺外科,对收治的CP患者中顽固性腹痛或合并阻塞性黄疸、胰管结石的21例患者实施了保留十二指肠的胰头切除术（DPPHR）,其中男15例,女6例,年龄31～48岁,平均（39±6）岁.14例采用改良DPPHR术式,7例采用Frey术式.观察患者术后6个月空腹血糖（FPB）、口服葡萄糖耐量试验（2 h-OGTT）、体重、疼痛评分（VAS视觉法）、腹泻症状及生活质量评估（GLQI量表）等诸项指标的改变.结果 本组患者无手术死亡病例,术后主要并发症是胰漏,5例患者术后出现胰漏,发生率为23.8%（5/21）.术后18例患者腹痛明显缓解,3例疼痛程度明显减轻但仍间或有上腹部疼痛发作.疼痛评分术后较术前明显下降（7.8±3.6与81.1±5.6,P＜0.05）.患者术后FPB值与术前比较差异无统计学意义[（5.3±0.4）mmol/L与（5.4±0.4）mmol/L,P＞0.05].术后2 h-OGTT值与术前比较差异亦无统计学意义[（8.0±0.6）mmol/L与（7.9±0.6）mmol/L,P＞0.05].未出现新发糖尿病病例.术后6个月患者体重均较术前有所增加,平均增加了（4.8±0.7）kg[（58.8±1.8）kg与（53.9±2.0）kg,P＜0.05）].患者生活质量总评分术后较术前亦明显提高（7 8.1±7.3与61.0±6.2,P＜0.05）.结论 DPPHR手术能确切缓解CP患者的疼痛,并不加重胰腺功能的破坏,有助于提高CP患者生活质量.

Objective To evaluate the therapeutic efficacy of duodenum-preserving pancreatic head resection （DPPHR） for severe chronic pancreatitis （CP）. Methods From February 2004 to March 2010,duodenum-preserving resection of pancreatic head was performed in 21 patients with severe CP. A ＂modified-DPPHR＂ was carried out in 14 patients of them and a ＂Frey＇s DPPHR＂ in the other 7 patients.The values of fasting plasma blood （FPB）, oral glucose tolerance test （ OGTT）, body weight （ BW）, visual analogue pain intensity scale （ VAS score） and the quality of life indices were evaluated before and 6th month after surgery. Results There was no hospital mortality. The complications from adjacent organs were resolved definitively. Pancreatic fistula was the major and the most frequent morbidity occurring in 23. 8% of the patients. After operation 85.7% of the patients were completely pain-free and 14. 3% had continuing abdominal pain. The VAS score decreased more after surgery comparing with before and there was a significant difference （81.1 ±5.6 vs 7. 8 ±3.6, P ＜0. 05）. The value of FPB in post-operative patients was similar to that in pre-operative ones and there was no significant difference [ （5.3 ±0. 4） mmol/L vs （5.4 ±0. 4） mmol/L, P ＞ 0. 05 ]. The value of 2 h-OGGT in post-operative patients was also similar to that in preoperative ones and it did not differ significantly [ （8.0 ± 0. 6） mmol/L vs （7. 9 ± 0. 6） mmol/L, P ＞ 0. 05 ].After operation 77.8% of patients gained more than 5% of their pre-operative body weight with a mean increment of （4. 8 ± 0. 7） kg （58.8 ± 1.8 vs 53.9 ± 2. 0, P ＜ 0. 05）. A significant rise of the overall quality of life index was observed after surgery （78. 1 ± 7. 3 vs 61.0 ± 6. 2, P ＜ 0. 05 ）. Conclusion DPPHR is both safe and effective with regard to pain relief, a definitive control of complications affecting adjacent organs and an improvement of overall quality of life. It leads to no further deterioration of pancreatic functions