胰管结石合并壶腹部周围病变的诊断及手术方式探讨  

Diagnosis and treatment of pancreatoiithiasis associated with peri-ampullary lesions

作　　者：洪德飞[1] 李松英[2] 许斌[1] 彭淑牖[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016 [2]浙江大学医学院病理科

出　　处：《中华普通外科杂志》2006年第11期792-794,共3页Chinese Journal of General Surgery

摘　　要：目的探讨胰腺结石合并壶腹部周围病变的诊断和手术方式。方法回顾性分析1994年4月-2005年10月32例胰管结石中8例合并壶腹部周围病变的临床资料。结果8例胰腺结石合并壶腹部周围病变患者中5例术前未获得明确诊断。3例胰管结石合并胰头癌患者行胰十二指肠切除、胰空肠捆绑吻合术,术后生存期分别为14个月、18个月和23个月;3例十二指肠乳头癌合并胰管结石行胰十二指肠切除、胰管切开取石、胰管端侧与空肠侧侧吻合术,分别已生存10个月、12个月和18个月;1例环状胰腺、十二指肠膜状闭锁合并胰腺结石行胰头部及环状胰腺、十二指肠球部和部分降部、胆管下端切除、十二指肠胰体尾捆绑吻合、胆肠吻合术;1例胰管结石合并胰腺钩突囊肿行囊肿切除、胰管与空肠侧侧吻合术,2例术后效果均良好。结论胰管结石患者应考虑合并壶腹部周围病变可能,合理选择手术方式不仅可以改善患者生活质量、还可以延长生存时间。Objective To evaluate the diagnosis and treatment of pancreatolithiasis associated with peri-ampullary lesions. Methods The clinical data of 8 patients with pancreatolithiasis associated with peri-ampullary lesions surgically treated in our hospital from April 1994 to October 2005 were retrospectively analyzed. Results In 5 out of the 8 cases of pancreatolithiasiss, the associated peri-ampullary lesions were overlooked preoperatively. Three patients underwent pancreaticoduodenectomy for complicated pancreatic cancer with postoperative survival of 14 months, 18 months, and 23 months respectively. Three patients received pancreaticoduodenectomy and pancreaticojejunostomy for associated duodenal papillary carcinoma and were alive on postoperative follow-up of 10 months, 12 months and 18 months respectively. One patient underwent resection of the pancreatic head, annular pancreas, and a portion of the duodenum with duodenopancreatostomy. One patient had resection of the pancreatic cyst and pancreaticojejunostomy. These 2 later cases were doing well after the surgery. Conclusions Pancreatolithiasis tends to complicate periampullary area with malignance. Suitable surgery can improve the quality of the patients＇ life and prolong survival time.

关 键 词：胰腺疾病 结石 肝胰管壶腹 外科手术 

分 类 号：R657.5[医药卫生—外科学]