胰管结石的临床诊断与治疗

The clinical diagnosis and treatment of 32 cases of pancreatic duct stones

目的探讨胰管结石的诊断、分型及治疗方法选择。方法回顾性分析2010年1月至2019年12月间上海健康医学院附属周浦医院收治的32例胰管结石临床资料,总结不同类型胰管结石的处理方法。结果32例患者术前均通过超声、CT及磁共振胰胆管造影(MRCP)等明确诊断。其中超声诊断正确率81.3%(26/32),CT诊断正确率86.2%(25/29),MRCP诊断正确率90.4%(19/21),内镜逆行胰胆管造影(ERCP)诊断正确率100%(8/8)。根据结石的位置及术中探查将胰管结石分为3型:I型17例,结石位于主胰管;Ⅱ型11例,结石位于主胰管和分支胰管;Ⅲ型4例,结石位于分支胰管。依据不同类型采用不同的治疗方式。全组围术期无死亡病例。术后共有并发症11例(34.3%),术后残石率为9.3%(3/32)。32例均获得随访,随访时间6~60个月不等,术后腹痛、脂肪泻等症状消失或明显减轻。2例合并胰腺癌者于术后12~35个月后因胰腺癌复发转移死亡。结论胰管结石处理复杂,影像学检查是确诊胰管结石的主要方法。胰管结石分型对其个体化治疗方法选择具有重要意义。外科手术是治疗胰管结石常用的重要手段。

Objective To investigate the diagnosis,classification and treatment of pancreatic duct stones(PDS).Methods Clinical data and prognosis of 32 patients with PDS treated in our hospital from Jan.2010 to Dec.2019 were retrospectively analyzed.The treatment methods were summarized.Results All 32 cases were diagnosed with PDS by imaging examinations such as B ultrasonography,CT,endoscopic retrograde cholangiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP).The diagnosis accuracy was 81.3%(26/32)for B-ultrasound,86.2%(25/29)for CT,90.4%(19/21)for MRCP,and 100%(8/8)for ERCP.According to the location of stones and intraoperative exploration,the 32 patients were divided into 3 groups:Type I,17 patients,the stones were located in the main pancreatic duct;TypeⅡ,11 patients,the stones were located in both main and branch pancreatic duct;TypeⅢ,4 patients,the stones were located in the branch pancreatic duct.Different treatment methods were employed according to the different types.No patient died in the perioperative period.11(34.3%)patients had postoperative complications.3(9.3%)patients had postoperative residual stones.32 cases were followed up for a period of 6 to 60 months.The abdominal pain and steatorrhea disappeared or significantly improved postoperatively.2 patients complicated with pancreatic cancer died 12 to 35 months after operation.Conclusions The treatment and diagnosis of the PDS still remains complicated.Imaging examinations are the main methods for diagnosis of PDS.The accurate classification and individual treatment are important.Surgery is the most commonly used method for PDS.