胰头切除治疗胰头部慢性胰腺炎不同术式疗效评价

Efficacy of different methods of pancreatic head resection for chronic pancreatitis of pancreas

目的探讨不同手术方式治疗胰头部慢性炎性反应的疗效。方法回顾性分析长海医院、武警上海总队医院和上海市第七人民医院从2000-01至2015-01收治的145例胰头部慢性胰腺炎患者的临床资料和随访信息,比较各种手术方式的临床疗效。结果术前伴有CA199升高、胰头肿块等怀疑恶变的患者多采用胰十二指肠切除术,术前伴有梗阻性黄疸、胰管结石等良性疾病的患者多采用保留十二指肠的胰头次全切除术,Beger术的总并发症率(P=0. 040)和胆漏发生率(P=0. 035),以及改良Beger术的总并发症率(P=0. 035)和胆漏发生率(P=0. 043)均高于改良Beger术联合胆肠吻合术式。结论选择胰头部慢性胰腺炎患者的手术方式时应遵循个体化原则。改良Beger术联合胆肠吻合术式较Beger术、改良Beger术式更能减少胆漏的发生。

Objective To explore and analyze the clinical effect of different surgical methods for chronic pancreatitis of heads of pancreas.Methods The clinical data and follow-up information of 145 patients with chronic pancreatitis in the head of pancreas admitted to Changhai Hospital,Shanghai Armed Police Corps Hospital and Shanghai Seventh People’s Hospital between January 2000 and January 2015 were retrospectively analyzed,and the clinical effects of various surgical methods were compared.Results Pancreatoduodenectomy was often used in patients with suspected malignancy such as elevated CA199 and pancreatic head mass.Patients with benign diseases,such as obstructive jaundice and pancreatic duct stones before operation,mostly underwent subtotal pancreatic head resection with duodenum preservation.The total rate of complications(P=0.040)and biliary leakage rate(P=0.035)of Beger’s operation,and those(P=0.035 vs P=0.043)of modified Beger’s operation were higher than those of modified Beger’s operation combined with cholangioenterostomy.Conclusions Individualized principles should be followed in the selection of surgical methods for patients with chronic pancreatitis of the head of pancreas.The modified Beger’s operation combined with cholangioenterostomy can reduce the occurrence of bile leakage more effectively.