胰管结石外科治疗体会  

Rational selection of surgical treatment for pancreatic duct stones

作　　者：何鑫 游建 金鑫[1] 肖定 刘贤莉 HE Xin;YOU Jian;JIN Xin(Department of General Surgery,Pu＇ai Hospital,Wuhan 430034,China)

机构地区：[1]华中科技大学同济医学院附属普爱医院普外科,武汉430034

出　　处：《临床外科杂志》2018年第7期530-531,共2页Journal of Clinical Surgery

摘　　要：目的总结胰管结石的分型、外科治疗方式的合理选择。方法胰管结石病人21例,分析不同类型病人胰管结石分型、治疗方式、术后并发症和临床疗效。结果全组均采用影像学B超、CT或MRCP检查确诊。将胰管结石分为四型:Ⅰ型:结石主要位于胰头部,主要是采用内镜取石,内镜治疗失败后行胰头十二指肠切除(Whipple手术);Ⅱ型:结石主要位于胰体部,主要采用内镜取石,内镜治疗失败后采用胰管切开取石、胰肠吻合(Partington手术);Ⅲ型:结石主要位于胰尾部,主要采用胰尾部加脾切除;(4)Ⅳ型结石广泛分布于头、体和尾部,主要采用胰头切除,大口径胰管切开取石加胰管空肠Roux-en-Y吻合术。结论在胰管结石治疗中应根据胰管结石的类型采用不同的手术方式,遵循个体化治疗原则。Objective To discuss the diagnosis and treatment of pancreatolithiasis. Methods The clinical data of 21 patients with pancreatolithiasis treated in our hospital were retrospectively analyzed. Classification,surgical procedures and postoperative complications of the pancreatic duct stone patients during perioperative period and the curative effect during follow-up were observed. Results The diagnosis of all cases was confirmed by imaging examinations（ such as B ultrasonography,CT or MRCP）.Pancreatolithiasis was classified into four types： Type Ⅰ,the stones were mainly located in the head of pancreas. Endoscopic pancreas drainage and remove stone was the first line choice of treatment. If it failed,the Whipple procedure would be applied. Type Ⅱ,the stones mainly located in the body of pancreas,Endoscopic pancreas drainage and remove stone was the first line choice of treatment. If it failed,it could be treated by Partington Procedure. Type Ⅲ,the stones mainly located in the tail of pancreas,resection of the tail of pancreas alone or combined with spleneetomy was the management of choice. Type Ⅳ,the stones were diffusely scattered in the main duct from the head to tail of pancreas,and pancreatoduodeneetomy,together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. Conclusion Based on the priciple of individualized treatment,reasonable surgical procedure should be choosed according to the classification of pancreatic duct stone.

关 键 词：胰管结石 外科手术 

分 类 号：R657.5[医药卫生—外科学]