慢性胰腺炎的个体化外科干预

Individualized surgical treatment for chronic pancreatitis

慢性胰腺炎发病机制复杂，病情进展多变，导致外科干预时机及手术方式的选择存在一定困难。慢性胰腺炎的治疗应依据个体化原则去除病灶，尽量保存正常胰腺实质，延缓胰腺内、外分泌功能损害的进程，改善患者生命质量，降低胰腺癌发生的风险。慢性胰腺炎患者早期可考虑保守和内镜治疗，胰管梗阻、狭窄合并结石、胰腺实质广泛钙化等慢性胰腺炎患者则需手术治疗。Frey术适合以胰管扩张和胰管结石为主的慢性胰腺炎患者，Beger术适合以胰头部炎性肿块或胰头部钙化为主的慢性胰腺炎患者。

Because of the complex pathogenesis and progressive development, it is difficult to define the optimal surgical time and procedure for chronic pancreatitis. The indi- vidualized treatment of chronic pancreatitis should resect the inflammatory mass of the head of the pancreas and preserve the pancreatic parenchyma to postpone the injury of pancreatic func- tion and improve life quality as well as decrease the risk for carcinogenesis of pancreatic cancer. Conservative and endoscopic treatment can be considered in the early stage, while surgical intervention should be applied for chronic pancreatitis with stenosis or obstruction of pancreatic duct and calcification of the pancreatic parenchyma. Frey procedure can be performed on patients only with stone in or dilation of pancreatic duct; patients with obvious inflammatory mass or calcification of the head of the pancreas should receive Beger procedure to decrease the morbidity of pancreatic cancer.