外科手术治疗胰管结石46例分析  

Surgical therapy for pancreatic duct stones, an analysis of 46 cases

作　　者：赵红川[1] 耿小平[1] 刘付宝[1] 潘树波[1] 谢坤[1] 王国斌[1] 黄帆[1] 

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《中华普通外科杂志》2015年第1期11-14,共4页Chinese Journal of General Surgery

摘　　要：目的探讨外科手术在胰管结石治疗中的价值。方法回顾性分析2008年1月至2013年12月间安徽医科大学第一附属医院普外科手术治疗46例胰管结石的临床资料。结果46例胰管结石患者中上腹痛42例，脂肪泻4例，合并糖尿病6例，血、尿淀粉酶升高4例，CAl9-9升高9例，胰腺癌5例，急性胰腺炎病史4例。所有患者术前均经影像学检查确诊为胰管结石。结石分布于胰头部21例，胰体（尾）部17例，充满型全胰管结石8例。7例患者为单发结石，28例为2～3枚，11例为3枚以上。2l例患者的结石最大直径〉1．0cm，25例的结石最大直径≤1．0am。手术方式：33例患者行胰管切开取石＋胰管空肠侧侧吻合术，8例行胰十二指肠切除术，5例行胰体尾联合脾脏切除术。6例患者术后出现并发症，并发症发生率13．0％（6／46）。全组无死亡病例。术后残石率为6．5％（3／46）。39例获得随访，随访率为87．5％（39／46），随访时间为3～57个月。疼痛缓解率为85．7％（36／42），结石复发率为4．3％（2／46）。结论外科手术是治疗胰管结石的重要方式；根据患者胰管结石的具体情况采用个体化手术治疗是取得良好疗效的关键。Objective To analyze the surgical treatment of pancreatic duct stones. Methods The clinical data of 46 patients with pancreatic duct stones treated in our hospital from January 2008 to January 2013 were retrospectively analyzed. Results The most common symptoms were abdominal pain in 47 patients, diarrhea in 4 patients, diabetes in 6 patients, increased level of amylase in 4 patients, high level of CA19-9 in 9 patients and concomitant pancreatic cancer in 5 patients. 4 patients had history of acute pancreatitis. All patients were diagnosed with pancreatic duct stones by preoperative imaging. The stones were located in the head of the pancreas in 21 cases, in pancreatic body and tail in 17 cases, and in the whole length of the pancreas in 8 cases. 7 cases had single stone, 28 cases had 2 to 3 stones, and 11 cases had more than three stones. 21 cases had stones with a maximum diameter more than 1.0 cm, and 25 cases with a maximum diameter less than l. 0 cm. Pancreatic lithotomy plus pancreaticojejunostomy was performed in 33 cases, pancreatoduodenectomy in 8 and resection of the body and tail of pancreas plus splenectomy in 5 cases. 6 （13.0%） patients had postoperative complications, and there was no mortality. 3 （6. 5 % ） patients had postoperative residual stones. 39 cases were followed up with follow-up time ranging from 3 months to 57 months. Pain relief rate was 85.7%, Stone occurred in 2 （4. 3% ） patients. Conclusions Surgery is an important treatment for pancreatic duct stones, and treatments should be adopted based on the situations of individual patients.

关 键 词：结石 胰腺疾病 外科手术 

分 类 号：R657.18[医药卫生—外科学]