不同手术方式治疗不同病变类型慢性胰腺炎的疗效及适应证分析

摘要

目的 探讨分析不同手术方式治疗不同病变类型慢性胰腺炎的临床疗效.方法 选取于2006年8月至2016年7月收治的慢性胰腺炎手术患者60例,将患者的胰腺影像病变特征分为以下四种:①A组7例,结石局限于胰腺体尾部,胰腺导管扩张、狭窄;②B组16例,主胰管局限性狭窄,胰腺萎缩,结石伴扩张;③C组21例,胰头多发性小胰管结石或胰头炎性肿大,伴有胰管结石或扩张;④D组16例,胰头多发结石伴潴留性囊肿.对患者根据适应症不同分别采取不同手术方式治疗,总结4组患者的随访信息和临床资料,比较分析手术治疗效果.结果 所有患者平均手术时间为(259.32±46.18)min.A组患者中5例(71.43%)患者行胰体尾切除术,B组患者中12例(75.00%)患者行纵向式胰肠吻合术(LPJ)手术,C组患者中14例(66.67%)患者行Frey手术,D组患者中12例(75.00%)患者行Frey手术.5例(8.33%)患者合并有胆道梗阻,4例患者行胆肠吻合.所有患者并发症总发生9例(15.00%),经非手术治疗均治愈.术后患者胰瘘发生5例,腹痛发生8例,腹泻发生13例,术后新发糖尿病患者9例,体重增加17例.术后全部患者保留十二指肠胰头切除术(DPPHR)术与Whipple术后腹痛发生率、腹泻发生率比较差异无统计学意义(P>0.05).结论 治疗不同病变类型慢性胰腺炎,不同手术方式的适应证不同,外科治疗时应遵循个体化原则,考虑患者病理形态改变的因素,以保证临床疗效.%Objective To investigate the clinical efficacy of different surgical methods in the treatment of different types of chronic pancreatitis.Methods 60 cases of chronic pancreatitis patients treated in our hospital were selected from August 2006 to July 2016.Pancreatic imaging lesions were divided into the following four types: ①A group with 7 cases, stones confined to the tail of the pancreas, pancreatic duct dilatation, stenosis.②B group with 16 cases, the main pancreatic duct localized stenosis, pancreatic atrophy, stones with expansion.③Group C with 21 cases, pancreatic head multiple small pancreatic duct stones or pancreatic inflammation, accompanied by pancreatic duct stones or expansion.④D group with 16 cases, pancreatic head with multiple retention of cysts.The follow-up information and clinical data of all patients were summarized.Results The average operation time was (259.32±46.18) min.5 cases (71.43%) of A group underwent distal pancreatectomy, 12 cases (75%) of B group underwent LPJ surgery, 14 cases (66.67%) of C group underwent Frey surgery, 12 cases (75%) of D group underwent Frey surgery.5 cases (8.33%) were complicated with biliary obstruction, and the other 4 patients were treated with biliary enteric anastomosis.In this study, the incidence of complications in all patients was 15%.There were no patient with perioperative death.Postoperative pancreatic fistula occurred in 5 cases, postoperative abdominal pain occurred in 8 cases, postoperative diarrhea occurred in 13 cases, postoperative new onset of diabetes in patients with weight gain in the case of 9 cases.There was no significant difference in the incidence of abdominal pain and diarrhea between DPPHR and Whipple after operation (P>0.05).Conclusion Different indications have different surgical methods,individualized principle should be followed in surgical treatment,to take into account the factors of patients with pathological changes, to ensure the clinical efficacy.