胰头肿块型自身免疫性胰腺炎手术治疗的临床效果

Clinical efficacy of surgical treatment for chronic pancreatitis with mass in the head of the pancreas

目的 探讨胰头肿块型自身免疫性胰腺炎（AIP）手术治疗的临床效果.方法 回顾性分析2008年5月至2013年5月吉林大学中日联谊医院收治的19例胰头肿块型AIP患者的临床资料,其中伴胆囊结石2例.采用剖腹探查根据术中病理检查结果进一步决定治疗方式.采用门诊及电话方式进行随访,随访时间截至2014年1月.结果 19例患者均成功完成手术,其中11例行胰十二指肠切除术,5例行单纯剖腹探查术,3例行胆囊切除＋胆肠吻合术.手术时间为（249±140） min（50 ～ 390 min）,术中出血量为（320±260） mL（50 ～ 900 mL）,术后平均胃肠功能恢复时间为3.0d（2.0～6.0 d）,术后平均住院时间为22.6 d（8.0～30.0 d）.12例患者术后IgG4水平升高,平均为2.64 g/L.患者术后发生并发症5例,其中胰液漏2例,手术切口脂肪坏死液化合并感染2例,胆汁漏1例,均经对症处理后痊愈.围手术期无患者死亡.19例患者均获得随访,随访时间为11.0 ～36.0个月,中位随访时间为28.2个月.8例未行胰十二指肠切除术患者出院后开始口服泼尼松,复查胰腺CT或MRI,均提示胰头肿块减小或消失.其余11例行胰十二指肠切除术患者均健康生存.结论 对不典型胰头肿块型病变比如AIP的治疗,应积极与患者及家属沟通,行剖腹探查术,术中穿刺活组织检查,根据病理检查结果,选择手术或药物治疗.

Objective To investigate the clinical efficacy of treatment for chronic pancreatitis and mass in the head of the pancreas.Methods The clinical data of 19 patients with chronic pancreatitis with mass in the head of the pancreas who were admitted to the China-Japan Union Hospital of Jilin University from May 2008 to May 2013 were retrospectively analyzed,including 2 patients with gallstone.Methods of treatment were selected by in traoperative pathological results.All the patients were followed up by outpatient examination and telephone interview till January 2014.Results The operations of the 19 patients were successfully done,including 11 with pancreaticoduodenectomy,5 with exploratory laparotomy and 3 with the laparoscopic cholecystectomy and choledochojejunostomy.The operation time and intraoperative blood loss were （249± 140）minutes （50-390 minutes） and （320 ± 260）mL （50-900 mL）.The postoperative mean time of recovery of gastrointestinal function and duration of postoperative hospital stay were 3.0 days （2.0-6.0 days） and 22.6 days （8.0-30.0 days） after the operation.The mean casein-IgG4 of 12 patients was higher （2.64 g/L） after operation.Five patients with operation-related complication were cured after symptomatic treatment,among 2 patients with leakage of the pancreatic fluid,2 with operative incision fat necrosis and liquefaction and 1 with bile leakage.No patients died perioperatively.Nineteen patients were followed up for 11.0 months to 36.0 months with the median time of 28.2 months.The pancreatic head mass of 8 patients with non-pancreaticoduodenectomy were reduced or disappeared by a computed tomography （CT） or magnetic resonance imaging （MRI） rescan,who were treated by the oral prednisone.No complications were detected in the other 11 patients with pancreaticoduodenectomy.Conclusion Method of surgery or medicine treatment for atypical mass in the head of the pancreas is selected according to the pathology results by effective communication with patients and family members,exploratory laparotomy and interpretative aspiration biopsy.