CAJ | 학술논문

目的探讨Frey手术治疗慢性胰腺炎的围手术期并发症及短期疗效.方法回顾性分析2009年2月至2012年9月接受Frey手术治疗的104例慢性胰腺炎患者的临床及随访资料.其中男性91例,女性13例；年龄16 ～ 75岁,平均(49±11)岁.结果患者围手术期病死率为0,并发症发生率24.0％ (25/104).胃排空延迟和胰漏是主要并发症,发生率分别为14.4％ (15/104)和6.7％(7/104).患者平均住院时间(10 ±3)d.平均随访时间(29±13)个月,8例失访,2例死亡,发生慢性胰腺炎癌变3例.87例术前疼痛患者疼痛缓解率和疼痛消失率分别为93.1％ (81/87)和66.7％(58/87).新增糖耐量异常和糖尿病分别为13例和10例；新增胰腺外分泌功能异常31例,其中12例需长期口服胰酶制剂.16例患者术后出现体重下降.术后再次入院10例,其中5例行再次手术治疗,包括1例假性囊肿,3例慢性胰腺炎癌变,1例影像学怀疑为恶变,病理学检查证实仍为慢性胰腺炎.结论 Frey手术是一种安全、有效的治疗慢性胰腺炎的手术方式,但应严格掌握手术适应证,并警惕慢性胰腺炎癌变的可能.
목적 탐토Frey수술치료만성이선염적위수술기병발증급단기료효.방법 회고성분석2009년2월지2012년9월접수Frey수술치료적104례만성이선염환자적림상급수방자료.기중남성91례,녀성13례；년령16 ～ 75세,평균(49±11)세.결과 환자위수술기병사솔위0,병발증발생솔24.0％ (25/104).위배공연지화이루시주요병발증,발생솔분별위14.4％ (15/104)화6.7％(7/104).환자평균주원시간(10 ±3)d.평균수방시간(29±13)개월,8례실방,2례사망,발생만성이선염암변3례.87례술전동통환자동통완해솔화동통소실솔분별위93.1％ (81/87)화66.7％(58/87).신증당내량이상화당뇨병분별위13례화10례；신증이선외분비공능이상31례,기중12례수장기구복이매제제.16례환자술후출현체중하강.술후재차입원10례,기중5례행재차수술치료,포괄1례가성낭종,3례만성이선염암변,1례영상학부의위악변,병이학검사증실잉위만성이선염.결론 Frey수술시일충안전、유효적치료만성이선염적수술방식,단응엄격장악수술괄응증,병경척만성이선염암변적가능.
Objective To analyze the perioperative complications and recent results of the Frey procedure in the treatment of chronic pancreatitis.Methods Between February 2009 and September 2012,104 patients with chronic pancreatitis underwent the Frey procedures.This study included 91 male and 13 female patients,with a mean age of (49 ± 11) years (range,16 to 75 years).The most common symptoms were abdominal pain in 97 patients,diarrhea in 10 patients,obstructive jaundice in 5 patients,and 5 patients had no symptoms.Nine patients had history of pancreatic surgery.Results There was no mortality.Perioperative complications occurred in 25 patients (24.0％),included pancreatic fistula in 7 patients,delayed gastric emptying in 15 patients,bleeding in 2 patients,abdominal infection in 1 patient,pulmonary infection in 2 patients,delayed healing incision in 4 patients,and pancreatic pseudocyst in 1 patient with reoperation.Seventeen patients with preoperative hyperamylasemia had a higher risk of intranperative hemorrhea and perioperative complications rates.At a mean follow-up of (29 ± 13) months,8 patients had missed,2 patients had died,and 3 patients was proved to be coexisted with pancreatic carcinoma.Among 87 patients with abdominal pain,58 patients (66.7％) have complete pain relief and 23 patients (26.4％) have substantial pain relief.However,among 5 patients without abdominal pain,2 had recurrent abdominal pain now.Seven of 17 patients with diabetes mellitus aggravated,and new onset of diabetes mellitus was observed in 10 patients.In addition,impaired glucose tolerance was developed in 13 patients.Among 10 patients with diarrhea,the symptom of 4 patients got worse.Thirty-one patients (33.7％) newly developed exocrine insufficiency,included 12 patients treated by patients oral administration of pancreatin and 19 patients only treated by diet control.Ten patients was readmitted and 5 patients underwent reoperation,included 1 patient of pancreatic pseudocyst,3 patients of chronic pancratitis coexisted with pancreatic carcinoma,and 1 patient of chronic pancratitis with abdominal pain and obstructive jaundice.Conclusions Frey procedure in the treatment of chronic pancreatitis is a safe technique with low mortality and morbidity rates,but indication should be strictly controlled and pancreatic tumorigenesis should be alerted.