腹腔镜下Frey手术治疗慢性胰腺炎的可行性和安全性  

Feasibility and safety of laparoscopic Frey’s procedure for chronic pancreatitis

作　　者：夏琦 蔡合 王昕[1,2] 吴仲[1,2] 高攀[1,2] 蔡云强 彭兵[1,2] XIA Qi;CAI He;WANG Xin;WU Zhong;GAO Pan;CAI Yunqiang;PENG Bing(Division of Pancreatic Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine/West China Hospital of Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普通外科胰腺外科病房,成都610041 [2]四川大学华西临床医学院/华西医院,成都610041

出　　处：《中国普外基础与临床杂志》2023年第9期1042-1046,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜下Frey手术治疗慢性胰腺炎的可行性和安全性。方法回顾性分析2021–2023年期间于四川大学华西医院普通外科胰腺外科病房接受腹腔镜下Frey手术的慢性胰腺炎患者的临床资料。结果研究纳入了11例确诊为慢性胰腺炎合并胰管结石患者,其中7例有糖尿病史和(或)糖耐量受损,提示胰腺内分泌功能受损。通过影像学方法测量主胰管直径为4~20 mm,中位数为8 mm;手术时间为120~368 min,中位数为188 min;术中总出血量为20~100 mL,中位数为50 mL。术后未发生胰瘘,术后发生腹腔积液及低蛋白血症者1例,采用抗感染、抑酸抑酶、营养补液等对症支持治疗后好转;术后发生出血3例,均考虑手术吻合口出血,其中1例系肠肠吻合口出血,于急诊下腹腔镜肠肠吻合口拆开再次缝合术止血;另2例考虑胰肠吻合口出血,采用输血、血浆、维生素K、抑酸、抑酶、止血药物等保守治疗后好转。术后住院时间为4~18 d,中位数为7 d;术后90 d内无患者死亡。结论腹腔镜下Frey术操作可行,是治疗慢性胰腺炎相对安全有效的手段。Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis.Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery,Department of General Surgery,West China Hospital,Sichuan University from 2021-2023 were retrospectively analyzed.Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study,7 of whom had a history of diabetes and(or)impaired glucose tolerance,suggesting that pancreatic endocrine function was impaired.The median diameter of the main pancreatic duct measured by imaging method was 8 mm(4–20mm).The median operative time was 188 min(120–368 minutes),and the total intraoperative bleeding volume was 50 mL(20–100 mL).Postoperative pancreatic fistula did not occur,one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection,acid and enzyme inhibition,and nutritional rehydration.Postoperative bleeding occurred in 3 cases,including 1 case of intestinal anastomotic bleeding,which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding.The other two cases improved after conservative management such as blood transfusion,plasma,vitamin K,acid inhibition,enzyme inhibition and hemostatic drugs.The median postoperative hospitalization time was 7 days(4–18 days),and no patient mortality happened within 90 days after surgery.Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.

关 键 词：慢性胰腺炎 Frey手术 腹腔镜 可行性 安全性 

分 类 号：R657.5[医药卫生—外科学]