胰头切除治疗胰头部慢性胰腺炎不同术式疗效评价
|
摘要
目的探讨不同手术方式治疗胰头部慢性炎性反应的疗效。方法回顾性分析长海医院、武警上海总队医院和上海市第七人民医院从2000-01至2015-01收治的145例胰头部慢性胰腺炎患者的临床资料和随访信息,比较各种手术方式的临床疗效。结果术前伴有CA199升高、胰头肿块等怀疑恶变的患者多采用胰十二指肠切除术,术前伴有梗阻性黄疸、胰管结石等良性疾病的患者多采用保留十二指肠的胰头次全切除术,Beger术的总并发症率(P=0. 040)和胆漏发生率(P=0. 035),以及改良Beger术的总并发症率(P=0. 035)和胆漏发生率(P=0. 043)均高于改良Beger术联合胆肠吻合术式。结论选择胰头部慢性胰腺炎患者的手术方式时应遵循个体化原则。改良Beger术联合胆肠吻合术式较Beger术、改良Beger术式更能减少胆漏的发生。
Objective To explore and analyze the clinical effect of different surgical methods for chronic pancreatitis of heads of pancreas. Methods The clinical data and follow-up information of 145 patients with chronic pancreatitis in the head of pancreas admitted to Changhai Hospital,Shanghai Armed Police Corps Hospital and Shanghai Seventh People's Hospital between January 2000 and January 2015 were retrospectively analyzed,and the clinical effects of various surgical methods were compared. Results Pancreatoduodenectomy was often used in patients with suspected malignancy such as elevated CA199 and pancreatic head mass. Patients with benign diseases,such as obstructive jaundice and pancreatic duct stones before operation,mostly underwent subtotal pancreatic head resection with duodenum preservation. The total rate of complications( P = 0. 040) and biliary leakage rate( P = 0. 035) of Beger's operation,and those( P = 0. 035 vs P = 0. 043) of modified Beger's operation were higher than those of modified Beger's operation combined with cholangioenterostomy. Conclusions Individualized principles should be followed in the selection of surgical methods for patients with chronic pancreatitis of the head of pancreas. The modified Beger's operation combined with cholangioenterostomy can reduce the occurrence of bile leakage more effectively.
Objective To explore and analyze the clinical effect of different surgical methods for chronic pancreatitis of heads of pancreas. Methods The clinical data and follow-up information of 145 patients with chronic pancreatitis in the head of pancreas admitted to Changhai Hospital,Shanghai Armed Police Corps Hospital and Shanghai Seventh People's Hospital between January 2000 and January 2015 were retrospectively analyzed,and the clinical effects of various surgical methods were compared. Results Pancreatoduodenectomy was often used in patients with suspected malignancy such as elevated CA199 and pancreatic head mass. Patients with benign diseases,such as obstructive jaundice and pancreatic duct stones before operation,mostly underwent subtotal pancreatic head resection with duodenum preservation. The total rate of complications( P = 0. 040) and biliary leakage rate( P = 0. 035) of Beger's operation,and those( P = 0. 035 vs P = 0. 043) of modified Beger's operation were higher than those of modified Beger's operation combined with cholangioenterostomy. Conclusions Individualized principles should be followed in the selection of surgical methods for patients with chronic pancreatitis of the head of pancreas. The modified Beger's operation combined with cholangioenterostomy can reduce the occurrence of bile leakage more effectively.
引文
[1]Stolte M,Weiss W,Volkholz H,et al.A special form of segmental pancreatitis:groove pancreatitis[J].Hepatogastroen terology,1982,29(5):198-208.
[2]秦仁义.胰腺病手术学[M].武汉:湖北科学技术出版社,2017.119-174.
[3]卢海松,王祥麒,姬卫国,等.中医综合疗法治疗晚期乳腺癌骨转移临床研究[J].中医药临床杂志,2016,18(4):531-534.
[4]Majumder S,Chari S T.Chronic pancreatitis[J].Lancet,2016,387(10031):1957-1966.
[5]中国医师协会胰腺病专业委员会慢性胰腺炎专委会.慢性胰腺炎诊治指南(2018,广州)[J].中华胰腺病杂志,2018,18(5):289-296.
[6]Sukharamwala P B,Patel K D,Teta A F,et al.Longterm outcomes favor uodenum-preserving pancreatichead resection over pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis:a Meta-analysis and systematic review[J].Am Surg,2015,81(9):909-914.
[7]Tanaka M.Gastroparesis after a pylorus-preserving pancreatoduodenectomy[J].Surg Today,2005,35(5):345-350.
[8]Seiler C A,Wagner M,Bachmann T,et al.Randomized clinical trial of pylorus preserving duodenopancreatectomy versus classical Whipple resection long term results[J].Br J Surg,2005,92(5):547-556.
[9]Roch AM,Brachet D,Lermite E,et al.Frey procedure in patients with chronic pancreatitis:short and long-term outcome from a prospective study[J].J Gastrointest Surg,2012,16(7):1362-1369.
[10]McClaine R J,Lowy A M,Matthews J B,et al.A comparison of pancreaticoduodenectomy and duodenum-preserving head resection for the treatment of chronic pancreatitis[J].HPB(Oxford),2009,11(8):677-683.
[11]Keck T,Adam U,Makowiec F,et al.Short and longterm results of duodenum preservation versus resection for the management of chronic pancreatitis:a prospective,randomized study[J].Surgery,2012,152(3 Suppl 1):S95-102.
[12]Ha P H.Results of treatment for chronic pancreatitis by the combined Frey and Beger procedure[J].J Visc Surg,2015,152(2):93-97.
[13]Khaled Y S,Ammori B J.Laparoscopic lateral pancreaticojejunostomy and laparoscopic Berne modification of Beger procedure for the treatment of chronic pancreatitis:the first UK experience[J].Surg Laparosc Endosc Percutan Tech,2014,24(5):e178-e182.
[14]谢思明,陈拥华,谭春露,等.Frey手术治疗慢性胰腺炎的围手术期并发症及近期疗效[J].中华外科杂志,2014,52(3):175-178.
[2]秦仁义.胰腺病手术学[M].武汉:湖北科学技术出版社,2017.119-174.
[3]卢海松,王祥麒,姬卫国,等.中医综合疗法治疗晚期乳腺癌骨转移临床研究[J].中医药临床杂志,2016,18(4):531-534.
[4]Majumder S,Chari S T.Chronic pancreatitis[J].Lancet,2016,387(10031):1957-1966.
[5]中国医师协会胰腺病专业委员会慢性胰腺炎专委会.慢性胰腺炎诊治指南(2018,广州)[J].中华胰腺病杂志,2018,18(5):289-296.
[6]Sukharamwala P B,Patel K D,Teta A F,et al.Longterm outcomes favor uodenum-preserving pancreatichead resection over pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis:a Meta-analysis and systematic review[J].Am Surg,2015,81(9):909-914.
[7]Tanaka M.Gastroparesis after a pylorus-preserving pancreatoduodenectomy[J].Surg Today,2005,35(5):345-350.
[8]Seiler C A,Wagner M,Bachmann T,et al.Randomized clinical trial of pylorus preserving duodenopancreatectomy versus classical Whipple resection long term results[J].Br J Surg,2005,92(5):547-556.
[9]Roch AM,Brachet D,Lermite E,et al.Frey procedure in patients with chronic pancreatitis:short and long-term outcome from a prospective study[J].J Gastrointest Surg,2012,16(7):1362-1369.
[10]McClaine R J,Lowy A M,Matthews J B,et al.A comparison of pancreaticoduodenectomy and duodenum-preserving head resection for the treatment of chronic pancreatitis[J].HPB(Oxford),2009,11(8):677-683.
[11]Keck T,Adam U,Makowiec F,et al.Short and longterm results of duodenum preservation versus resection for the management of chronic pancreatitis:a prospective,randomized study[J].Surgery,2012,152(3 Suppl 1):S95-102.
[12]Ha P H.Results of treatment for chronic pancreatitis by the combined Frey and Beger procedure[J].J Visc Surg,2015,152(2):93-97.
[13]Khaled Y S,Ammori B J.Laparoscopic lateral pancreaticojejunostomy and laparoscopic Berne modification of Beger procedure for the treatment of chronic pancreatitis:the first UK experience[J].Surg Laparosc Endosc Percutan Tech,2014,24(5):e178-e182.
[14]谢思明,陈拥华,谭春露,等.Frey手术治疗慢性胰腺炎的围手术期并发症及近期疗效[J].中华外科杂志,2014,52(3):175-178.