【摘要】 目的探讨胰管盆式内引流术在亚急性期慢性胰腺炎治疗中的应用和效果。方法回顾性分析2016年12月至2018年6月在湖南省人民医院行胰管盆式内引流术治疗的11例亚急性期慢性胰腺炎患者临床资料。其中男10例,女1例;年龄13～69岁,中位年龄40岁。患者均签署知情同意书,符合医学伦理学规定。合并胰管结石9例,胰腺假性囊肿11例,胰周脓肿5例。患者均行胰管盆式内引流术,打开胰管,清理结石或胰周假性囊肿及脓肿后,与扩张的胰管拼合呈盆状,行胰管盆-空肠Roux-en-Y吻合,合并胆囊结石者同时行胆囊切除术,观察患者术后恢复和并发症发生、复发情况。结果 11例患者均顺利完成手术,手术时间中位数3.5(2.5～4.5)h,术中出血量80(50～100)ml,术后拔管时间7(3～10)d。术后出现生化瘘3例,予适当延长拔管时间均愈合,未出现B、C级胰瘘,无出血、腹腔感染、吻合口瘘,无死亡病例。住院期间91%(10/11)患者腹痛明显好转。术后随访期间仅1例患者发生上腹部疼痛,复查CT示慢性胰腺炎改变,其余患者无明显慢性胰腺炎症状复发。结论胰管盆式内引流术可有效治疗亚急性期慢性胰腺炎。更多还原

【Abstract】 Objective To investigate the application and effect of basin-type internal drainage of the pancreatic duct in the treatment of sub-acute chronic pancreatitis. Methods Clinical data of 11 patients with sub-acute chronic pancreatitis undergoing basin-type internal drainage of the pancreatic duct in People’s Hospital of Hunan Province from December 2016 to June 2018 were retrospectively analyzed. Among them,10 patients were male and 1 female, aged 13-69 years with a median age of 40 years. The informed consents of all patients were obtained and the local ethical committee approval was received. 9 cases were complicated with pancreatic duct stones, 11 cases complicated with pancreatic pseudocysts and 5 cases complicated with peri-pancreatic abscess. All patients underwent basin-type internal drainage of the pancreatic duct. After the pancreatic duct was incised, the stones, peri-pancreatic pseudocysts or abscesses were cleared, the dilatate pancreatic duct was designed in a basin shape. Roux-en-Y anastomosis of the pancreatic duct basin-jejunum was performed. Cholecystectomy was performed simultaneously for patients complicated with gallbladder stones. Postoperative recovery, incidence of complications and recurrence of the patients were observed.Results All 11 patients completed the operation successfully. The median operation time was 3.5(2.5-4.5) h. The intraoperative blood loss was 80(50-100) ml. The postoperative extubation time was 7(3-10) d. 3 case developed biochemical fistula, which were healed after the extension of extubation time. No grade B or C pancreatic fistula occurred. No hemorrhage, abdominal infection, anastomotic fistula or death occurred. During hospitalization, 91%(10/11) of the patients presented with significant improvement in abdominal pain. During the postoperative follow-up, only 1 case suffered from the upper abdominal pain. CT scan demonstrated the changes of chronic pancreatitis. No recurrence of typical chronic pancreatitis symptoms was observed in the other patients. Conclusion Basin-type internal drainage of the pancreatic duct can effectively treat the sub-acute chronic pancreatitis.更多还原