中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (09): 809-811.

• 论著 • 上一篇    下一篇

从病理解剖学探讨慢性胰腺炎手术治疗的合理性

高红桥，蔡梦珊，马永蔌，陈国卫，庄    岩，杨尹默   

  1. 北京大学第一医院普通外科，北京100034
  • 出版日期:2011-09-01 发布日期:2011-08-19

  • Online:2011-09-01 Published:2011-08-19

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摘要：

目的    探讨病理解剖学改变对慢性胰腺炎手术方式选择的指导意义，评价外科治疗的远近期效果，为设计合理化手术方案提供临床依据。方法    回顾性研究北京大学第一医院2000-2010年外科治疗60例慢性胰腺炎病人的临床资料。结果    围手术期死亡1例（1.7%）。60例慢性胰腺炎病人合并腹痛43例（71.7%），42例手术后疼痛获缓解，远期复发17例（40.5％）。合并胰管扩张和（或）胰管结石行改良Puestow术21例，远期复发8例（38.1%）；6例行不同范围胰头切除术者未见症状复发，11例仅行胆肠吻合者2年内疼痛复发9例（81.2%）。合并胆道梗阻者33例（55%），单纯或联合其他手术的胆肠吻合均能缓解黄疸，单纯胆肠吻合后33.3%（4/12）新发腹痛，5例胰头切除术后病人长期随访无黄疸和腹痛复发。结论    根据慢性胰腺炎病理解剖学改变选择具针对性手术效果良好，合理的切除加充分的胰胆引流可显著改善临床症状。

关键词: 慢性胰腺炎, 手术治疗, 病理解剖学, 引流术, 切除术

Abstract:

Rationality of surgical managements according to the pathological anatomy of chronic pancreatitis        GAO Hong-qiao, CAI Meng-shan, MA Yong-su, et al. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Corresponding author: YANG Yin-mo, E-mail: yangyinmo@263.net
Abstract    Objective    To investigate the outcome after surgery directed by pathological anatomy of chronic pancreatitis and provide evidence for surgical procedures. Methods    The clinical material of 60 patients with chronic pancreatitis who underwent surgical treatment between 2000 and 2010 were investigated retrospectively. Result    43 cases (71.7%)  presented with abdominal pain, Perioperative mortality was 1.7% (1 case). Forty-two patients with abdominal pain were all relieved after surgery, but long-term recurrence occered in 17 cases  (40.5%). Modified Puestow procedure was performed on 21 patients with dilatation of pancreatic duct and/or lithiasis,  long-term pain recurrence occered in 8 cases (38.1%);  Six patients undergoing pancreatic head resection had no recurrence in the long-term follow-up; Pain recurrence rate of 11 cases with only cholangioenterostomy was 81.2% (9 cases) within 2 years. Chronic pancreatitis with common bile duct obstruction occurred in 33 cases(55%), cholangioenterostomy alone or combined with partly pancreatic resection or pancreatic duct drainage procedures could alleviate symptoms of biliary obstruction, 4(33.3%) cases after pure biliary drainage emerged abdominal pain, 5 cases of pancreatic head resection had no recurrence of jaundice and abdominal pain after long-term follow-up. Conclusion    Surgical procedures should be selected according to the pathological anatomy of chronic pancreatitis. Reasonable pancreatic head resection and adequate bile and/or pancreatic drainage could significantly improve the long-term outcomes.

Key words: chronic pancreatitis, surgical procedure, pathological anatomy, drainagel, resection