保留十二指肠的胰头切除术与胰管切开取石胰腺管空肠吻合术在胰腺头部结石中的临床疗效

Clinical Effect of Duodenum-Preserving Pancreaticohead Resection And Pancreaticojejunostomy for Pancreatic Head Calculi

目的探讨保留十二指肠的胰头切除术(duodenum-preserving pancreatic head resection,DPPHR)与胰管切开取石胰腺管空肠吻合术(Partington手术)对于胰腺头部结石手术治疗的疗效差别,评估二者手术的优缺点,并对其进行一定的优化和改进。方法通过回顾性分析2017年1月1日至2022年10月1日以来,昆明医科大学第二附属医院肝胆胰外科一至四病区收治的139例需行手术治疗的胰腺头部结石患者的临床、影像和病理资料;根据对患者所施行的手术方式不同,将其分为DPPHR组和Partington组,分析2组患者临床特征以及外科治疗的近期和远期疗效。结果术前一般资料分析差异均无统计学意义(P>0.05);DPPHR组以Ⅰ型结石为主(80.2%),而Partington组以Ⅰ、Ⅲ型结石为主(45.3%、47.2%),差异有统计学意义(P<0.001);近期疗效中,DPPHR组在手术时间、术中出血量、术后住院天数和术后并发症发生率方面较Partington组具优势(P<0.05);远期疗效中,DPPHR组在结石复发再手术、术后胰腺功能等方面均优于Partington组(P<0.05);Logistic多因素分析显示CP≥5 a(95%CI 1.057~3.884,P=0.012)、术后长期有饮酒史(95%CI 0.987~3.128,P=0.025),CP≥5a和术后长期有饮酒史均是影响胰腺头部结石术后无疼痛复发生存期的独立危险因素。结论胰腺头部结石患者近期疗效(手术时间、术中出血量、术后住院天数和术后并发症发生率)和远期疗效(结石复发再手术、术后胰腺功能)分析,DPPHR手术均优于Partington术,可认为DPPHR手术目前成为一种有效的治疗PDS的方法;但还需为患者制定个体化手术策略,并重视术后护理和随访,以便为患者提供最佳预后。

Objective To explore the difference between duodenum-preserving pancreatic head resection( DPPHR) and pancreatic-preserving pancreatic duct jejunostomy( Partington operation) in the treatment of pancreatic head calculus,and evaluate the advantages and disadvantages of the two operations,and optimize and improve them. Methods From January 1,2017 to October 1,2022,the clinical,imaging and pathological data of 139 patients with pancreatic head stones requiring surgical treatment admitted to the Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed. According to the different surgical methods,the patients were divided into DPPHR group and Partington group. The clinical characteristics of patients in the two groups and the short-term and long-term outcomes of surgical treatment were analyzed. Results There was no significant difference in preoperative general data(P >0.05). Type Ⅰ stones were predominant in DPPHR group(80.2%),while type Ⅰ and Ⅲ stones were predominant in Partington group(45.3%,47.2%),and the difference was statistically significant(P < 0.001). In terms of shortterm efficacy,DPPHR group had advantages over Partington group in terms of operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication rate(P < 0.05). In the long-term efficacy,the DPPHR group was better than the Partington group in stone recurrence reoperation and postoperative pancreatic function(P < 0.05). Logistic multivariate analysis showed that CP≥5 a(95%CI 1.057-3.884,P = 0.012) and long postoperative drinking history( 95%CI 0.987-3.128, P = 0.025). CP≥5 a and a long history of postoperative alcohol consumption were independent risk factors for survival without pain recurrence after pancreatic head calculi surgery Conclusions Based on the analysis of the short-term efficacy(operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication rate) and long-term efficacy( stone recurrence and reoperation, postoperative pancreatic function) of patients with pancreatic head calculi in this study, DPPHR surgery was superior to Partington surgery,suggesting that DPPHR surgery has become an effective treatment for PDS at present. However,it is also necessary to develop an individualized surgical strategy for the patient,with emphasis on postoperative care and follow-up to provide the best outcome for the patient.