保留十二指肠胰头切除术治疗胰头部肿块型慢性胰腺炎的疗效

Efficacy of duodenum-preserving pancreatic head resection for chronic pancreatitis with mass in the head of the pancreas

目的探讨保留十二指肠的胰头切除术主要术式Beger术与Berne术治疗胰头部肿块型慢性胰腺炎的疗效。方法回顾性分析2008年9月至2012年4月贵阳医学院附属医院收治的46例胰头部肿块型慢性胰腺炎患者的临床资料。其中24例行Beger术（Beger组），22例行Berne术（Berne组）。评估患者术后并发症、生命质量、疼痛程度。采用电话和门诊随访，随访时间截至2013年4月。计量资料采用Mann．WhitneyU检验；率或构成比的比较采用矿检验或连续校正矿检验。结果Beger组患者手术时间和术中出血量分别为（377±21）min和（746±129）mL，Berne组分别为（323±17）min和（577±111）mL，两组比较，差异有统计学意义（U=14．0，88．0，P〈0．05）。Beger组患者术后发生胰液漏4例，Berne组术后发生胰液漏1例，两组比较，差异无统计学意义（x2=0．714，P〉0．05）。生命质量功能评估（身体状况、工作能力、认知力、情绪、社会、总体生命质量）：Beger组患者分别为（82±14）分、（74±24）分、（90±18）分、（78±20）分、（83±18）分、（73±18）分；Berne组分别为（79±16）分、（71±20）分、（92±21）分、（76±18）分、（80±21）分、（70±16）分，两组比较，差异均无统计学意义（U=177．5，183．5，187．5，178．0，189．5，192．0，P〉0．05）。生命质量症状评估（疲劳、恶心及呕吐、疼痛、食欲不振、呼吸困难、睡眠障碍、便秘、腹泻、财务焦虑）：Beger组患者分别为（28±16）分、（24±10）分、（20±12）分、（23±14）分、（4±1）分、（32±12）分、（6±2）分、（18±14）分、（36±18）分；Berne组分别为（26±18）分、（26±20）分、（22±16）分、（26±16）分、（3±1）分、（30±10）分、（5±1）分、（16±12）分、（38±20）分，两组比较，差异均无统计学意义（U=194．5，215．5，182．5，180．5，213．0，199．0，195．0，184．5，181．5，P〉0．05）。疼痛程度评估：Beger组患者中，19例无急性发作，5例发生频率1次／年，18例没有使用止痛药，6例偶尔使用；Berne组患者中，20例无发作，2例发生频率1次／年，18例没有使用止痛药，4例偶尔使用，两组患者在疼痛急性发作和使用止痛药方面比较，差异无统计学意义（x2=0．485，0．041，P〉0．05）。46例患者均获随访，平均随访时间为36．3个月。患者生存良好，均无十二指肠穿孔、脂肪泻等并发症发生，无死亡病例。结论Berne术治疗胰头部肿块型慢性胰腺炎的疗效与Beger术相当，但Berne术操作简单，能明显缩短手术时间，便于临床推广应用。

Objective To investigate the clinical efficacy of two types of duodenum-preserving pancreatic head resection （Beger procedure and Berne procedure） for chronic pancreatitis with mass in the head of the pancreas. Methods The clinical data of 46 patients with chronic pancreatitis and mass in the head of the pancreas who were admitted to the Affiliated Hospital of Guiyang Medical College from September 2008 to April 2012 were retrospectively analyzed. There were 24 patients received Beger procedure （ Beger group）, and 22 received Berne procedure （Berne group）. The complications, life quality and pain after the operation were evaluated. Patients were followed up via phone call and out-patient examination till April 2013. The measurement data were analyzed using the Mann-Whitney U test, and the constituent ratios were compared using the chi-square test. Results The operation time and volume of blood loss were （377 ± 21 ）minutes and （746 ± 129）mL in the Beger group, and （ 323 ± 17 ） minutes and （577 ± 111 ） mL in the Berne group, with significant difference between the 2 groups （ U = 14. 0, 88.0, P 〈 0.05）. Four patients in the Beger group and 1 in the Berne group were complicated with pancreaticleakage, with no significant difference between the 2 groups （X2= 0. 714, P 〉 0.05 ）. The scores of life quality evaluation （physical condition, work capacity, cognitive ability, emotion, social competence and overall life quality） were 82 ± 14, 74 ±24, 90 ± 18, 78 ±20, 83 ± 18, 73 ± 18 in the Beger group, and 79 ± 16, 71 ±20, 92 -±21, 76 ± 18, 80 ± 21,70 ± 16 in the Berne group, with no significant difference between the 2 groups （ U = 177.5, 183.5, 187. 5, 178. 0, 189. 5, 192. 0, P 〉 0.05）. The scores of symptom evaluation （fatigue, nausea and vomitting, pain, anorexia, dyspnea, sleep disorders, obstipation, diarrhea, financial worries） were 28 ± 16, 24 ± 10, 20 ± 12, 23 ± 14, 4 ± 1, 32 ± 12, 6 -±2, 18 ± 14, 36 ± 18 in the Beger group, and 26 ± 18, 26 ±20, 22 ± 16, 26 ± 16, 3 ± 1, 30 ± 10, 5 ± 1, 16 ± 12, 38 ± 20 in the Berne group, with no significant difference between the2groups （U=194.5, 215.5, 182. 5, 180. 5, 213.0, 199.0, 195.0, 184. 5, 181.5, P〉0.05）. In the Beger group, 19 patients did not have acute onset of pain, and 5 patients had acute onset of pain once a year; 6 patients were administered antalgesic occasionally. In the Berne group, 20 patients did not have acute onset of pain, and 2 patients had acute onset of pain once a year; 4 patients were administered antalgesic occasionally, with no significant difference between the 2 groups （X2 = 0. 485, 0. 041, P 〉 0.05 ）. All the patients were followed up, and the median time of follow-up was 36.3 months. No perforation of duodenum and steatorrhea was observed. No patient died perioperatively. Conclusion The clinical efficacy of the Berne procedure is similar to that of the Beger procedure, while the Berne procedure has advantages of easy manipulation and less operation time.