慢性胰腺炎的外科治疗

Surgical Management for Chronic Pancreatitis

目的 改善慢性胰腺炎的外科治疗效果。方法 回顾性分析我院外科 1983 2 0 0 0年收治的 3 4例慢性胰腺炎病人的临床资料 ,并将其分为慢性钙化性胰腺炎及慢性梗阻性胰腺炎两组。结果 男性 2 3例 ( 68% ) ,女性 11例 ( 3 2 % ) ,平均年龄 5 2 89岁。嗜酒者 2 3例 ( 67 65 % ) ,合并胆石症者13例 ( 3 8.2 4 % ) ,继往有急性胰腺炎发作者 11例 ( 3 2 3 5 % )。主诉腹痛者 2 8例 ( 82 3 5 % ) ,合并黄疸者17例 ( 5 0 % )。慢性钙化性胰腺炎与慢性梗阻性胰腺炎在某些临床表现间存在显著性差异 ,提示二者可能存在不同的发病机制。 3 4例病人分别采用 9种不同的手术方式 ,无围手术期死亡。Puestow手术及胰十二指肠切除可有效地缓解疼痛 ,并可改善胰外分泌功能 ,对胰内分泌的影响不大。Puestow手术并行胆肠吻合适于合并胆道狭窄的慢性胰腺炎病人 ,而仅行胆道引流效果不佳。结论 慢性胰腺炎的外科治疗应采用个体化原则 ,如合并胰管扩张可行Puestow引流手术 。

Objective To improve the clinical outcome of surgical management for chronic pancreatitis. Methods 34 patients with chronic pancreatitis undergoing operation in our hospital from 1983-2000 were analyzed retrospectively, who were divided into chronic calcifying pancreatitis and chronic obstructive pancreatitis according to the clinical manifestations. Results There were 23 men (68%) and 11 women (32%) with a mean age of 52.89 years. The cause of chronic pancreatitis was alcohol related in 23 cases (67.65%), cholelithiasis in 13 (38.24%), and previous episodes of acute pancreatitis in 11(32.35%). Clinical manifestations included abdominal pain in 28cases (82.35%), obstructive jaundice in 17cases(50%). There existed a significant difference in some clinical materials between the two groups of chronic calcifying pancreatitis and chronic obstructive pancreatitis, which might mean the different pathologic basis in the two kinds of chronic pancreatitis. A total of 34 patients underwent nine different operations without perioperative deaths. Both the Puestow procedure and the pancreatoduodenectomy was safe and achieved pain relief in a large percentage of patients, which could also improve the exocrine function whereas the endocrine function remained unchanged. Addition of biliary bypass to the Puestow procedure was suitable for the patients with stenosis of common bile duct. Only drainage of bile duct had poor outcome for the patients with chronic pancreatitis. Conclusion The clinicopathologic characteristics of chronic pancreatitis was variable and the surgical management should be also different for individuals. When a dilated ductal system was encountered, drainage procedures should be recommended. Resection should be performed for the patients with inflammatory mass in the head of pancreas.