CAJ | 학술논문

目的分析慢性胰腺炎(CP)外科治疗效果,探讨如何合理选择手术方式.方法回顾性分析2007年1月至2011年12月哈尔滨医科大学第一附属医院手术治疗的54例CP患者的病例资料.结果本组54例CP患者均行手术治疗,其中8例行单纯减压引流术(Partington术)；13例行切除术,包括7例胰十二指肠切除术(PD)、4例胰体尾部联合脾切除术、1例胰体尾部切除术(DP)及1例胰十二指肠联合胰体尾部切除术；12例行切除+减压引流术,包括7例Beger术及5例Frey术；21例行其他手术(15例胰腺假性囊肿空肠吻合术,4例剖腹探查、胰腺组织活检术及2例胃空肠吻合、胆总管空肠吻合术).术后病理证实4例CP已合并癌变.12例出现各种术后并发症,均经非手术治疗而治愈,无院内死亡病例.44例(81.5％)获得随访,随访时间2～ 67个月.42例术前明显腹痛者中36例(85.7％)获得持续缓解；术后新发糖尿病1例,无新发脂肪泻病例.结论对于具备外科手术指征的CP患者,应以最大程度地保留胰腺内、外分泌功能为目的,遵循个体化治疗原则,合理选择手术方式,同时要兼顾手术的安全性及有效性.
목적 분석만성이선염(CP)외과치료효과,탐토여하합리선택수술방식.방법 회고성분석2007년1월지2011년12월합이빈의과대학제일부속의원수술치료적54례CP환자적병례자료.결과 본조54례CP환자균행수술치료,기중8례행단순감압인류술(Partington술)；13례행절제술,포괄7례이십이지장절제술(PD)、4례이체미부연합비절제술、1례이체미부절제술(DP)급1례이십이지장연합이체미부절제술；12례행절제+감압인류술,포괄7례Beger술급5례Frey술；21례행기타수술(15례이선가성낭종공장문합술,4례부복탐사、이선조직활검술급2례위공장문합、담총관공장문합술).술후병리증실4례CP이합병암변.12례출현각충술후병발증,균경비수술치료이치유,무원내사망병례.44례(81.5％)획득수방,수방시간2～ 67개월.42례술전명현복통자중36례(85.7％)획득지속완해；술후신발당뇨병1례,무신발지방사병례.결론 대우구비외과수술지정적CP환자,응이최대정도지보류이선내、외분비공능위목적,준순개체화치료원칙,합리선택수술방식,동시요겸고수술적안전성급유효성.
Objective To analyze the results of surgical treatment on chronic pancreatitis(CP),and investigate how to choose the appropriate surgical procedure.Methods The clinical data of 54 patients with chronic pancreatitis who underwent surgery at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.Results All the 54 patients underwent surgery,including 8 decompression and drainage procedure (Partington procedure) ; 13 resections (7 cases of pancreaticoduodenectomy,1 case of distal pancreatectomy,4 cases of distal pancreatectomy combined with splenectomy and 1 case of pancreaticoduodenectomy combined with distal pancreatectomy,respectively); 12hybrids (7 cases of Beger procedure and 5 cases of Frey procedure,respectively) and 21 other procedures (15 cases of pancreatic pseudocyst jejunostomy,4 cases of exploratory laparotomy combined with pancreatic tissue biopsy,2 cases of gastrojejunostomy combined with choledochojejunostomy,respectively).There were 4 cases of post-operative pathologic evidence of cancer.Twelve patients had postoperative complications and were cured with non-operative management.Forty-four patients (81.5％) were followed for 2 to 67 months,36 out of 42(85.7％) patients who suffered from abdominal pain had a persistent remission,there were one case of new on-set diabetes and no steatorrhea was reported.Conclusions For CP patients with surgical indications,the choice of procedure should be individualized for the purpose of preserving the endocrine and exocrine functions of pancreas,and taking effectiveness as well as safety into consideration.