改良Beger手术效果及并发症预防体会

Effect of modified Beger operation and prevention of postoperative complications

目的探讨改良Beger手术效果及并发症的预防措施。方法回顾性分析2014年1月至2020年1月临沧市人民医院收治行手术治疗的31例慢性胰腺炎、胰头良性及低度恶性肿瘤患者的临床资料,其中胰头肿块型慢性胰腺炎26例,胰头囊肿合并胰管结石2例,胰头实性假乳头状瘤1例,导管内乳头状黏液性肿瘤1例,胰头浆液性囊腺瘤1例。手术方式均采用改良Beger手术。结果术后短期内出现并发症4例(12.9%),其中胰瘘3例,胆瘘1例。29例患者获随访6个月~5年,发生脂肪泻2例。无肿瘤或结石复发,无手术后新发糖尿病、反流性胆管炎等。术前术后Izbicki疼痛评分[(49.25±3.18)vs(12.21±1.34)]、GLQI量表评分[(62.13±3.36)vs(89.96±2.36)]、体质量指数(BMI)[(29.23±3.57)kg/m^(2) vs(34.31±3.56)kg/m^(2)]比较,差异均具有统计学意义(P<0.05)。结论保证十二指肠及壶腹部充足的血供,掌握精细的胰颈横断及胰头次全切技术,是预防改良Beger手术并发症的关键措施。Beger手术创伤小,术后并发症少,可长期持续缓解慢性胰腺炎患者的疼痛及提高生活质量。

Objective To analyze the effect of modified Beger operation and prevention of postoperative complications.Methods A retrospective analysis was condueted in 31 patients with chronic pancreatitis,benign and low-grade malignant tumors of the head of pancreas who underwent surgical treatment in Lincang People’s Hospital from Jan.2014 to Jan.2020.Among 31 patients,26 cases with mass type chronic pancreatitis in the head of pancreas,2 cases with cyst of pancreatic head combined with pancreatic duct stones,1 case with solid pseudopapillary tumor,1 case with intraductal papillary mucinous tumor and 1 case with serous cystadenoma of the head of pancreas.All patients received modified Beger operation.Results After modified Beger operation,4 cases(12.9%)developed short-term complications,including pancreatic leakage occured in 3 cases and bile leakage in 1 case.And 29 patients were followed-up for 6 months to 5 years,among them only 2 cases developed fatty diarrhea.No tumor or stone recurrence,no postoperative diabetes or reflux cholangitis.The preoperative and postoperative Izbicki pain score[(49.25±3.18)vs(12.21±1.34)],GLQI score[(62.13±3.36)vs(89.96±2.36)]and BMI[(29.23±3.57)kg/m^(2) vs(34.31±3.56)kg/m^(2)]were all statistically different(P<0.05).Conclusion In order to ensure sufficient blood supply for duodenum and ampulla,the key measures to prevent the postoperative complications of modified Beger operation are to master the skilled technique of pancreatic neck transection and subtotal pancreatectomy.Modified Beger operation has advantages with small trauma and fewer postoperative complications,which can continuously relieve the pain and improve the life quality of patients with chronic pancreatitis for a long time.