微创理念下慢性胰腺炎胰管结石的个体化治疗

Individualized treatment for chronic pancreatitis with pancreatic duct stones under the concept of minimally invasive surgery

目的探讨在微创理念下采用ERCP或外科手术,个体化选择最适合的方案,改善慢性胰腺炎胰管结石的治疗效果。方法回顾性分析我院2007年2月至2014年3月采用ERCP介入或外科手术治疗慢性胰腺炎胰管结石38例患者的临床资料。结果 32例(84.2%)患者接受ERCP介入治疗,成功27例;11例(含5例内镜治疗失败者)采用外科手术治疗。完全ERCP组疼痛治疗有效率为85.2%(23/27),手术组有效率为72.7%(8/11)。糖尿病和腹泻情况在ERCP及手术治疗前后无明显变化。未发生围手术期死亡病例。随访期间1例死于糖尿病肾衰,1例死于胰腺癌。结论慢性胰腺炎胰管结石确诊后在微创理念下强调以个体化治疗为原则的综合治疗。采用内镜技术的微创治疗以及尽可能保留胰腺组织和功能的微创手术方式,均可以取得较为满意的治疗效果。

Objective To explore the application of ERCP and other surgical procedures under the concept of minimally invasive surgery,individual choice of the most appropriate operation,to improve the treatment effect of chronic pancreatitis with pancreatic duct stones.Methods The clinical data of 38 patients with chronic pancreatitis combined pancreatic duct stones who received endotherapy and surgical managements in our hospital from Feb.2007 to Mar.2014 were retrospectively analyzed.Results Of the 38 patients,32patient（84.2%） received endotherapy,and 27 cases were successful.Surgical managements performed for 11cases（including 5 cases of endoscopic treatment failure）.Effective rate was 85.2%（23/27） in full endotherapy and72.7%（8/11） in surgical managements.Before and after the two treatments,changes of diabetes mellitus and diarrhea were not obvious.There was no perioperative deaths.During the follow-up 1 case died of diabetes renal failure,1 case died of pancreatic cancer.Conclusion After diagnosis of chronic pancreatitis with pancreatic duct stones,comprehensive treatment under the concept of minimally invasive surgery is suggested.Minimally invasive treatment with endoscopic technique and small invasive operation mode as far as possible to retain the pancreatic tissues and functions,which can obtain satisfactory therapeutic effect.