胰石症的诊断与治疗体会(附16例报告)

Experience in diagnosis and treatment of pancreatolithiasis:a report of 16 cases

目的 探讨胰管石症的诊断与治疗方法。方法 回顾性总结我院1977～2002年6月收治的16例病人,3例合并胰腺癌,2例合并胰头部囊肿,1例合并胆总管囊肿,其中手术治疗10例,十二指肠乳头切开取石3例,拒绝手术自动出院3例。结果 胰石症多以上腹痛为首发症状,B型超声、ERCP、CT等确诊率高,其中B型超声为首选检查方法,CT对胰管结石合并胰腺癌有很好的定性定位价值,ERCP可清晰显露胰管结石,对胰头部结石可行十二指肠乳头切开取石。本组行胰管切开取石、胰管空肠吻合术8例,2例胰管结石合并胰腺癌的病人分别行“胰体尾部联合脏器切除术”和“胰腺癌扩大根治术加自体小肠移植”,内镜下十二指肠乳头切开取石3例,加做胰腺囊肿切开内引流术2例,胆总管囊肿切除1例。结论 B型超声为诊断胰石症的首选检查法,首选术式为胰管切开取石,胰管空肠吻合术。CT对胰管结石合并胰腺癌有很好的定性定位价值,强调制定“个体化手术治疗方案”治疗胰管结石合并胰腺癌的病人。

Objective To discuss methods for diagnosis and treatment of pancreatolithiasis. Methods The clinical data of 16 patients with pancreatolithiasis surgically treated in our hospital from 1977 to June 2002 were retrospectively analyzed. Of the 16 patients, 3 were complicated with pancreatic cancer, 2 with pancreatic cyst in the head and 1 with choledochal cyst. Ten patients received operation, 3 endoscopic sphincterotomy (EST) and other 3 refused operation and left the hospital. Results Epigastric pain was the major symptom. Ultrasonography, ERCP and CT were of higher rate in correct diagnosis of the disease. Ultrasonography was the best choice for its diagnosis. CT was of high value in determining features and location of pancreatolithiasis complicated with pancreatic cancer. ERCP could clearly show the pancreatic stone and could be used for EST to remove the stones in the pancreatic head. Amongst the 16 patients, 8 underwent pancreatolithotomy plus side-to-side pancreati-cojejunostomy, 3 EST, 2 incision and internal drainage of pancreatic cyst and 1 choledocystectomy. Conclusions Ultrasonography is of the first choice for diagnosis of pancreatolithiasis and pancreatolithotomy plus side-to-side pancreaticojejunostomy is the best choice for its treatment. CT is of high value in determining features and location of pancreatolithiasis complicated with pancreatic cancer. In surgical treatment of patients with pancreatolithiasis complicated with pancreatic cancer, the principle of individualized therapy should be followed.