CAJ | 학술논문

目的总结慢性胰腺炎外科手术方式的选择以及治疗效果的评价.方法回顾分析2002年10月至2011年10月24例北京友谊医院以慢性胰腺炎行外科手术治疗的24例患者资料.结果 24例患者术前均诊断为慢性胰腺炎,其中22例术中及术后病理证实为慢性胰腺炎,2例根据术中所见及术后病理结果证实为慢性胰腺炎癌变；临床表现包括上腹痛24例,梗阻性黄疸4例,十二指肠梗阻1例,门静脉高压症伴腹腔积液2例,脂肪泻1例,继发性糖尿病者5例；有单纯酗酒史者9例,有单纯胆石症病史者4例,酗酒合并胆石症病史者5例,特发型慢性胰腺炎6例.手术方式包括胰十二指肠切除术(Whipple手术)6例,保留十二指肠的胰头切除加胰肠侧侧吻合术(Frey手术)1例,改良Frey手术(Izbicki手术)1例,胰管纵行切开减压胰肠侧侧吻合术加空肠侧侧吻合术(改良Partington-Rochelle手术)15例,胰体尾及脾切除术1例.无手术死亡病例,术后并发症有胆漏1例.患者均获得随访,随访时间7个月至9年,无一例发现癌变,腹痛复发同术前者4例.结论对于慢性胰腺炎患者,建议根据其临床分型选择手术方式；胰头肿块型慢性胰腺炎应积极手术治疗；术后应鼓励戒酒.
목적 총결만성이선염외과수술방식적선택이급치료효과적평개.방법 회고분석2002년10월지2011년10월24례북경우의의원이만성이선염행외과수술치료적24례환자자료.결과 24례환자술전균진단위만성이선염,기중22례술중급술후병리증실위만성이선염,2례근거술중소견급술후병리결과증실위만성이선염암변；림상표현포괄상복통24례,경조성황달4례,십이지장경조1례,문정맥고압증반복강적액2례,지방사1례,계발성당뇨병자5례；유단순후주사자9례,유단순담석증병사자4례,후주합병담석증병사자5례,특발형만성이선염6례.수술방식포괄이십이지장절제술(Whipple수술)6례,보류십이지장적이두절제가이장측측문합술(Frey수술)1례,개량Frey수술(Izbicki수술)1례,이관종행절개감압이장측측문합술가공장측측문합술(개량Partington-Rochelle수술)15례,이체미급비절제술1례.무수술사망병례,술후병발증유담루1례.환자균획득수방,수방시간7개월지9년,무일례발현암변,복통복발동술전자4례.결론 대우만성이선염환자,건의근거기림상분형선택수술방식；이두종괴형만성이선염응적겁수술치료；술후응고려계주.
Objective To summarize the choices of surgical operation modes and the evaluation of therapeutic effect on chronic pancreatitis.Methods The clinical data of 24 cases of chronic pancreatitis undergoing surgical operations were retrospectively analyzed in Beijing friendship hospital from October 2002 to October 2011.Results All 24 cases were all diagnosed of chronic pancreatitis before operation.22 cases were identified of chronic pancreatitis according to the findings of operation and postoperative pathology; the other 2 cases were identified of chronic pancreatitis canceration according to the findings of operation and postoperative pathology.The symptom included abdominal pain (24 cases),obstructive jaundice (4 cases),obstruction of duodenum (1 case),portal hypertension complicated ascites (1 case),steatorrhea (1 case) and diabetes mellitus (5 cases).The histories included alcohol abuse only (9 cases),cholelithiases only (4 cases),alcohol abuse combined with cholelithiases (5 cases) and idiopathic (6 cases).The operation modes included pancreaticoduodenectomy (Whipple) 6 cases,duodenum-preserving pancreatic head resection and pancreaticojejunostomy (Frey procedure) 1 case,modified Frey procedure (Izbicki procedure) 1 case,longitudinal pancreaticojejunostomy and jejunum anastomosis (modified Partington-Rochelle procedure) 15 cases,distal pancreatectomy and splenectomy 1 case.There was no operative death.Postoperationg complications included biliary leakage (1 case).All patients got postoperation follow-up,ranging from 7 months to 9 years.None was found canceration of chronic pancreatitis.4 cases had abdominal pain recurrence.Conclusions Tthe most suitable surgery procedure of chronic pancreatitis should be chosen according to clinical types.Surgical procedure should be suggested in patients of chronic pancreatitis with mass in the head of pancreas.Giving up alcohol should be encouraged after operation.