胰管结石诊断与手术方式选择的荟萃分析  

Diagnosis and surgical strategy of pancreatic duct stones:a meta-analysis

作　　者：毛先海[1] 李灼日[1] 吴金术[1] 何自力[1] 蒋波[1] 刘初平[1] 

机构地区：[1]湖南省人民医院湖南师范大学第一附属医院肝胆外科,湖南长沙410005

出　　处：《中国现代医学杂志》2010年第14期2234-2236,共3页China Journal of Modern Medicine

摘　　要：目的探讨胰管结石的临床诊断方法与手术治疗方式选择。方法通过电子检索CNKI数据库对1990年以来病例数报道较多的5个中心的文献资料,对总计211例胰管结石病例进行荟萃分析。结果荟萃分析结果显示,B超、CT和MRCP对胰管结石的诊断阳性率较高,其中B超为84.8%、CT为91.4%、MRCP为96.6%。胰管结石首选手术治疗,术式主要为:胰管切开取石+胰管空肠Roux-en-y吻合术(61.7%)、胰十二指肠切除术(20.8%)、胰体尾切除术(11.5%)。术后死亡1例,术后并发胰腺癌4例。结论胰管结石的确诊主要依赖B超、CT和MRCP等影像学检查;其有效手术方式的选择应根据胰管结石的分布类型而定;胰十二指肠切除术在胰管结石的治疗中有着重要价值。【Objective】 To explore the diagnosis and surgical management of pancreatic duct stones.【Methods】A meta-analysis was performed with a total of 211 cases of pancreatic duct stones from five centers where more cases of this disease were reported in CNKI electronic database from 1990 to present.【Results】The meta-analysis results showed that B-ultrasonic（B-US）,computed tomography（CT） and MRCP were much better surveillance tools than others in diagnosis of pancreatic duct stones,and the positive predictive values were 84.8%,91.4% and 96.6% respectively.Surgery was still the treatment of first choice.Four mainly surgical procedures were performed on the 211 patients,including the opening of the main pancreatic duct plus construction of pancrecticojejunostomy（61.7%）,pancreaticoduodenectomy（20.8%）,the resection of pancreatic body and tail（11.5%）.After operation,1 case died and 4 cases had developed into pancreatic cancer.【Conclusion】The diagnosis of pancreatic duct stones is mainly dependent on the examination of Bus,CT and MRCP;the effective surgical strategy of pancreatic duct stone should be based on the distribution types of pancreatic stone;pancreatoduodenectomy has an important value in the treatment of pancreatic duct stones.

关 键 词：胰管结石 诊断 治疗 胰十二指肠切除术 

分 类 号：R657.5[医药卫生—外科学]