Chen Han-Ming, Jan Yi-Yin, Chao Tsu-Che, Hwang Tsann-Long, Chen Miin-Fu
Department of Surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei, Taiwan.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2213-7.
BACKGROUND/AIMS: In chronic pancreatitis patients with an inflammatory mass of the pancreatic head receiving pancreatoduodenectomy, postoperative quality of life, including nutritional status, has become important. Pre- and postoperative evaluation of pancreatic function is essential as an effective means of proper nutritional management of patients following pancreatoduodenectomy.
Fifteen patients with chronic pancreatitis and inflammatory mass of the pancreatic head who had received standard pancreatoduodenectomy were enrolled in this investigation. All patients had their biliary and pancreatic ducts reconstructed according to Child's arrangement. Furthermore, all patients had smooth postoperative courses and were assessed for the pancreatojejunostomy by magnetic resonance cholangiopancreatography at least a month after the initial operation. Exocrine pancreas functions were clinically assessed with various clinical items and two indirect pancreatic function tests: the fecal elastase test and the Bentiromide test. Endocrine pancreas functions were assessed using serum C-peptide level, HbA1 level and the need for hypoglycemic therapy.
The results indicated that the pancreatojejunostomies of all patients are patent magnetic resonance cholangiopancreatography. All patients benefited from the selected symptom relief and various clinical parameters, including medications, dietary restrictions, body mass index and plasma albumin levels, experiencing pain relief and improved exocrine and endocrine functions.
Pancreatic function did not deteriorate after pancreatoduodenectomy for chronic pancreatitis with an inflammatory mass of pancreatic head, while quality of life was significantly improved.
背景/目的：在接受胰十二指肠切除术的慢性胰腺炎合并胰头炎性肿块患者中，术后生活质量，包括营养状况，已变得至关重要。术前和术后评估胰腺功能是对胰十二指肠切除术后患者进行适当营养管理的有效手段。
15例患有慢性胰腺炎和胰头炎性肿块并接受标准胰十二指肠切除术的患者纳入本研究。所有患者均按照Child法重建胆管和胰管。此外，所有患者术后病程顺利，在初次手术后至少1个月通过磁共振胰胆管造影对胰肠吻合口进行评估。通过各种临床指标以及两项间接胰腺功能试验：粪便弹性蛋白酶试验和苯替酪胺试验对胰腺外分泌功能进行临床评估。使用血清C肽水平、糖化血红蛋白水平和降糖治疗需求评估胰腺内分泌功能。
结果表明，所有患者的胰肠吻合口在磁共振胰胆管造影下均通畅。所有患者均从选定的症状缓解和各种临床参数中获益，包括药物治疗、饮食限制、体重指数和血浆白蛋白水平，疼痛得到缓解，外分泌和内分泌功能得到改善。
对于慢性胰腺炎合并胰头炎性肿块患者，胰十二指肠切除术后胰腺功能未恶化，而生活质量显著改善。
