CAJ | 학술논문

目的探讨慢性胰腺炎外科治疗的手术方式选择.方法回顾性分析2000年1月至2013年8月北京大学第一医院收治的80例慢性胰腺炎患者的临床资料,其中胰管扩张＞7 mm、伴或不伴胰管结石者38例,胆总管扩张者44例,伴有胰头部炎性肿块者32例,脾大伴食管胃底静脉曲张3例.根据患者临床症状及影像学表现综合判断手术指征及选择手术方式.根据VAS疼痛分级标准评估患者术后疼痛缓解及复发.通过门诊复查、信件或电话访谈方式随访,随访时间截至2013年12月.结果胆肠吻合术27例,Partington-Rochelle术24例,Partington-Rochelle术+胆肠吻合术6例,胰十二指肠切除术7例,胰体尾切除术4例,Beger术3例,脾切除术3例,Frey术+胰头内胆管开窗术3例,Frey术2例,胆总管探查+T管引流术1例.63例以腹痛为主要表现的患者术后腹痛缓解率达95.2％ (60/63).围手术期1例患者因腹腔感染并发MODS死亡.围手术期并发症7例,包括腹腔感染3例、胰瘘2例、胆瘘1例、腹腔出血1例,所有并发症经保守治疗治愈.79例患者获得随访,平均随访时间为58.6个月(4～ 156个月).30例腹痛复发或出现新发腹痛症状,总复发率为38.0％(30/79).32例胰头部炎性肿块患者中,17例因胆管扩张合并梗阻性黄疸仅行胆肠吻合术,术后腹痛复发率达9/17;另15例分别行胰十二指肠切除术、Beger术或Frey术,术后腹痛复发率为1/15.41例胰腺萎缩或弥漫炎性改变患者中,10例仅行胆肠吻合术者腹痛复发率达7/10;30例Partington-Rochelle术患者腹痛复发率为33.3％ (10/30).结论对胰管扩张的慢性胰腺炎患者,充分引流可有效缓解症状;对于胰头部炎性肿块慢性胰腺炎患者,应选择手术切除或联合术式.
목적 탐토만성이선염외과치료적수술방식선택.방법 회고성분석2000년1월지2013년8월북경대학제일의원수치적80례만성이선염환자적림상자료,기중이관확장＞7 mm、반혹불반이관결석자38례,담총관확장자44례,반유이두부염성종괴자32례,비대반식관위저정맥곡장3례.근거환자림상증상급영상학표현종합판단수술지정급선택수술방식.근거VAS동통분급표준평고환자술후동통완해급복발.통과문진복사、신건혹전화방담방식수방,수방시간절지2013년12월.결과 담장문합술27례,Partington-Rochelle술24례,Partington-Rochelle술+담장문합술6례,이십이지장절제술7례,이체미절제술4례,Beger술3례,비절제술3례,Frey술+이두내담관개창술3례,Frey술2례,담총관탐사+T관인류술1례.63례이복통위주요표현적환자술후복통완해솔체95.2％ (60/63).위수술기1례환자인복강감염병발MODS사망.위수술기병발증7례,포괄복강감염3례、이루2례、담루1례、복강출혈1례,소유병발증경보수치료치유.79례환자획득수방,평균수방시간위58.6개월(4～ 156개월).30례복통복발혹출현신발복통증상,총복발솔위38.0％(30/79).32례이두부염성종괴환자중,17례인담관확장합병경조성황달부행담장문합술,술후복통복발솔체9/17;령15례분별행이십이지장절제술、Beger술혹Frey술,술후복통복발솔위1/15.41례이선위축혹미만염성개변환자중,10례부행담장문합술자복통복발솔체7/10;30례Partington-Rochelle술환자복통복발솔위33.3％ (10/30).결론 대이관확장적만성이선염환자,충분인류가유효완해증상;대우이두부염성종괴만성이선염환자,응선택수술절제혹연합술식.
Objective To investigate the surgical procedure selection for chronic pancreatitis.Methods The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed.Thirty-eight patients were with or without pancreatic duct stone,and the dilation of the pancreatic duct was above 7 mm,44 patients were with common bile duct dilation,32 patients were with inflammatory mass in the head of the pancreas,and 3 patients were with splenomegaly and esophagogastric varices.Surgical procedures were selected according to the symptoms and results of imaging examination.The remission or recurrence of pain was judged according to the visual analog scales.Patients were followed up via out-patient examination,mail or phone call till December 2013.Results Choledochojejunostomy was done on 27 patients,Partington-Rochelle pancreaticojejunostomy on 24 patients,PartingtonRochelle pancreaticojejunostomy + choledochojejunostomy on 6 patients,pancreaticoduodenectomy on 7 patients,resection of the body and tail of the pancreas on 4 patients,Beger's procedure on 3 patients,splenectomy on 3 patients,Frey's procedure + fenestration of bile duct in the head of the pancreas on 3 patients,Frey's procedure on 2 patients,common bile duct exploration + T tube drainage on 1 patient.The remission rate of abdominal pain was 95.2％ (60/63).One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively.Three patients were complicated with abdominal infection,2 with pancreatic fistula,1 with biliary fistula and 1 with abdominal bleeding.All the complications were cured by conservative treatment.Seventy-nine patients were followed up,and the mean time of follow-up was 58.6 months (range,4-156 months).Thirty patients had recurrence or new onset of abdominal pain,and the recurrence rate was 38.0％ (30/79).Of the 32 patients with inflammatory mass in the head of the pancreas,17 received choledochojejunostomy,and the recurrence rate of abdominal pain was 9/17 ; the other 15 patients received pancreatoduodenectomy,Beger' procedure or Frey's procedure,and the recurrence rate of abdominal pain was 1/15.Of the 41 patients without inflammatory mass,10 received choledochojejunostomy,and the recurrence rate of abdominal pain was 7/10; 30 received PartingtonRochelle pancreaticojejunostomy,and the recurrence rate of abdominal pain was 33.3％ (10/30).Conclusions Complete drainage could relieve the symptoms for patients with pancreatic duct dilation.Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.