15例胰管结石的诊断及治疗  

Diagnosis and Therapy of Pancreatic Duct Stones: A Report of 15 Cases

作　　者：曾锦生[1] 赵慧[2] 李勇[1] 蔡军[1] 余永欢[1] 方宁国[1] 

机构地区：[1]南昌大学第一附属医院普外科,南昌330006 [2]南昌大学图书馆,南昌330006

出　　处：《南昌大学学报（医学版）》2012年第11期40-42,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的总结胰管结石的诊断和治疗经验。方法对2007年10月至2011年12月15例胰管结石的临床资料进行回顾性分析。结果 15例胰管结石均与慢性胰腺炎合并存在,其中4例有胰管切开取石、胰肠吻合手术史。各种影像学检查手段对胰管结石的检出率(阳性例数/检查总例数)为:常规超声10/12;内镜超声2/2;CT检查6/10;MRI或磁共振胰胆管水成像(MRCP)6/8;经内镜逆行胰管造影(ERCP)3/3。2例未行内镜或手术治疗;4例行内镜治疗者1例取净结石,另3例行内镜下胰胆管引流;2例行胰头十二指肠切除术,7例行胰管切开取石、胰管空肠吻合术。15例患者出院时腹痛症状均完全缓解,无并发症发生。出院后,14例得到随访,随访时间3～25个月。其中行手术治疗的9例,术中均取净结石,随访期间腹痛症状消失且影像学未再发现胰管结石;2例未给予内镜或手术治疗者及3例内镜取石不成功者,腹痛症状有好转,但未完全消失。结论胰管结石的诊断依赖于综合应用各种影像学检查手段,超声检查可作为首选检查。手术是治疗胰管结石的主要方法,最常用的术式是胰管切开取石、胰管空肠吻合术;内镜下取石、引流是一个可以考虑的治疗选择。Objective To summarize the experience with diagnosis and therapy of pancreatic duct stones.Methods The clinical data of 15 cases of pancreatic duct stones（Oct 2007-Dec 2011） were analyzed retrospectively.Results Fifteen of the 15 cases had chronic pancreatitis.Among them,4 cases had a history of undergoing pancreatolithotomy and pancreaticojejunostomy.The detection rate of pancreatic duct stones（number of positive cases/total number of cases） was 10/12 by conventional ultrasound,2/2 by endoscopic ultrasound,6/10 by CT,6/8 by MRI or magnetic resonance cholangiopancreatography,and 3/3 by endoscopic retrograde cholangiopancreatography.Endoscopic or surgical treatment was not performed in 2 cases.Stones were removed completely in 1 of 4 cases who underwent endoscopic treatment and endoscopic pancreatic duct drainage was performed in other 3 cases.The pancreatoduodenectomy was carried out in 2 cases and pancreatolithotomy combined with pancreaticojejunostomy in 7 cases.All patients achieved complete remission of abdominal pain without complications at discharge from hospital.Among the 14 patients who were followed-up for 3-25 months after discharge,9 received operative treatment and achieved complete removal of stones,and abdominal pain disappeared and no recurrences of pancreatic duct stones were found by imaging determination in the 9 patients.Abdominal symptoms were improved but did not completely disappear in 2 patients who did not receive endoscopic or surgical treatment and 3 patients who underwent unsuccessful endoscopic treatment.Conclusion The diagnosis of pancreatic duct stones relies on the comprehensive application of all kinds of imaging examinations,and ultrasound can be considered a first choice.Surgery is the main method for the treatment of pancreatic duct stones,and pancreatolithotomy combined with pancreaticojejunostomy is the most commonly used surgical method.In addition,endoscopic pancreatic drainage combined with stone removal can be considered a choice.

关 键 词：胰管结石 影像学检查 手术治疗 内科治疗 

分 类 号：R657.5[医药卫生—外科学]