60例胰管结石患者的外科治疗  

Surgical treatment of patients with pancreatic ductal stones： a report of 60 cases

作　　者：李文杰[1] 吕少诚[1] 顾万清[1] 梁雨荣[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853

出　　处：《中华肝胆外科杂志》2015年第11期758-760,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：吴阶平医学基金（320.6750.11010）

摘　　要：目的探讨手术治疗胰管结石的围术期并发症及预后。方法对2009年1月至2014年12月解放军总医院手术治疗的60例胰管结石患者临床资料进行回顾性分析。其中男性47例，女性13例，平均年龄（44．1±12．0）岁。所有患者术前均由影像学手段确诊并全部行外科手术治疗。结果本组患者无围术期死亡，并发症发生率11．7％（7／60），其中胰漏4例，胃排空延迟、腹腔感染、吻合VI出血各1例。术后高淀粉酶血症者8例。禁食时间及术后住院时间分别为（3．4±1．2）d和（10．0±4．0）d。平均随访时间27个月，随访率88．3％（53／60）。57例术前腹痛患者中51例获得随访，其中43例（84．3％）在随访期间未出现腹痛症状，7例（13．7％）偶有腹痛，较术前明显缓解。术前确诊糖尿病患者15例，随访14例，其中1例症状缓减，2例血糖基本正常，新发2例，均在术后2年。2例术后病理证实胰腺癌变的患者1例失访，1例于术后27个月去世。3例术后病理证实为上皮不典型增生患者复查尚未见明显恶变。结论胰管结石与慢性胰腺炎多伴行存在，引起胰腺内外分泌功能的紊乱。外科手术在减缓患者不适症状、延缓胰腺功能损害等方面作用显著。Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones. Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study. There were 47 males and 13 fetnales. The average age was （44. 1 ± 12. 0）. Results All patients underwent surgical operation and there was no perioperative death. Perioperative complications occurred in 7 patients （11.7% ） , including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient. Eight patients developed elevated amylase levels. The fasting time was 3.4 ± 1.2 days and the hospital stay was 10. 0 ±4. 0 days. The follow-up rate was 88. 3% （53/60）, at a mean follow-up of 27 months. In 51 patients who presented with abdominal pain, 43 patients （84. 3% ） had complete pain relief and 7 patients （ 13.7% ） had partial pain relief. In 14 patients with pre- operative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes. Two additio- nal patients were diagnosed to have diabetes two years after the operation. Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation. The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer. Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close. Chronic pancreatitis also caused exocrine and endocrine dysfunction. Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

关 键 词：胰管结石 胰管空肠吻合术 诊断 治疗 

分 类 号：R573.8[医药卫生—消化系统]