Schnelldorfer Thomas, Adams David B
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Am Surg. 2003 Dec;69(12):1041-4; discussion 1045-6.
In order to evaluate surgical outcome after lateral pancreaticojejunostomy (LPJ) in patients with pancreas divisum (PD), we compared the operative results in patients who underwent LPJ for PD with those who underwent LPJ for other causes of chronic pancreatitis. The records of 129 patients who underwent LPJ for chronic pain associated with chronic pancreatitis from 1995 through 2001 were retrospectively reviewed and analyzed. There were 21 patients (11 men, 10 women, mean age 40 years) who had PD as a cause of chronic pancreatitis. The remaining 108 patients (58 men, 50 women, mean age 48 years) had chronic pancreatitis of other etiologies. The two groups had a similar stage of disease progress measured by incidence of pancreatic duct strictures, terminal biliary stenosis, pseudocysts, insulin dependency, need for pancreatic enzymes, and symptom duration. There was no difference in operative time (200 +/- 13.3 vs. 206 +/- 6.1 minutes) or intraoperative blood loss (200 vs. 300 mL) comparing the PD to the other group. The overall postoperative morbidity (14% vs. 23%) and mortality (0% vs. 2%) were not significantly different in PD versus other group comparison. Hospital length of stay was similar in both groups (7.0 +/- 2.4 vs. 8.0 +/- 1.3 days). In the PD group 10 per cent required reoperation with pancreatic resection for failure of LPJ to improve chronic pain versus 9 per cent in the other group. Comparison of patients who undergo LPJ for PD with those who undergo LPJ for other etiologies showed no significant difference in failure rates as measured by the need for reoperation. Postoperative morbidity and mortality were similar in both groups. Failure of LPJ in patients with PD may be related to factors associated with failure of LPJ in management of chronic pancreatitis of other causes. This includes inadequate drainage of the head of gland, failure to drain small ducts, and perineural inflammation.
为了评估胰腺分裂症（PD）患者行胰管空肠侧侧吻合术（LPJ）后的手术效果，我们比较了因PD行LPJ的患者与因其他慢性胰腺炎病因行LPJ的患者的手术结果。回顾性分析了1995年至2001年间因慢性胰腺炎相关慢性疼痛而行LPJ的129例患者的病历。其中有21例（11例男性，10例女性，平均年龄40岁）患者因PD导致慢性胰腺炎。其余108例患者（58例男性，50例女性，平均年龄48岁）患有其他病因的慢性胰腺炎。通过胰管狭窄、终末胆管狭窄、假性囊肿、胰岛素依赖、胰酶需求及症状持续时间的发生率来衡量，两组疾病进展阶段相似。比较PD组与另一组，手术时间（200±13.3分钟对206±6.1分钟）或术中失血量（200毫升对300毫升）无差异。PD组与另一组比较，总体术后发病率（14%对23%）和死亡率（0%对2%）无显著差异。两组住院时间相似（7.0±2.4天对8.0±1.3天）。PD组中有10%的患者因LPJ未能改善慢性疼痛而需要再次行胰腺切除术，另一组为9%。比较因PD行LPJ的患者与因其他病因行LPJ的患者，再次手术需求所衡量的失败率无显著差异。两组术后发病率和死亡率相似。PD患者LPJ失败可能与其他病因慢性胰腺炎LPJ治疗失败相关因素有关。这包括胰头引流不充分、小胰管引流不畅及神经周围炎症。
