Farkas Gyula, Leindler László, Farkas Gyula, Daróczi Mária
University of Szeged, Faculty of Medicine, Department of Surgery, Hungary.
Magy Seb. 2004 Oct;57(5):279-82.
In chronic pancreatitis (CP), enlargement of the head of the pancreas develops in consequence of inflammatory alterations. A new safe procedure has been developed for duodenum-preserving pancreatic head resection, and this prospective report is concerned with the results attained with this operation.
In 94 patients a new surgical management was performed after the development of an inflammatory tumour of the pancreatic head. The preoperative morbidity comprised frequent abdominal pain, a weight loss in all patients, jaundice in 8 patients, and latent and insulin-dependent diabetes mellitus in 8 and 8 patients, respectively. The diagnosis was confirmed by ERCP, sonography and CT. Pancreatic functions were checked by means of the amylium tolerance test (ATT), the glucose tolerance test and stool elastase. The surgical procedure consisted in a local resection of the inflammatory tumour in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, took place through a jejunal Roux-en-Y loop. In 8 icteric cases and in 12 patients with stenosis of the common bile duct, prepapillary bile duct anastomosis was also performed with the jejunal loop.
Only one reoperation was performed, in consequence of anastomosis bleeding, but no mortality was noted in the postoperative and follow-up period. The duration of hospitalization ranged between 7 and 12 days, with a median of 8.5 days. In the median follow-up period of 24 months (range 6 to 42), all the patients became complaint-free, and the weight increased by a mean of 10 kg (range 4-25). The ATT and the stool elastase level demonstrated an exocrine function improvement, no significant change was noted in the preoperative endocrine function.
The results clearly reveal that this organ-preserving pancreatic head resection is a safe and effective procedure for definitive control of the complications following the inflammatory alterations of CP.
在慢性胰腺炎（CP）中，胰腺头部的肿大是由炎症改变引起的。已经开发出一种新的安全手术方法用于保留十二指肠的胰头切除术，本前瞻性报告关注的是该手术所取得的结果。
94例患者在胰头炎性肿瘤形成后接受了新的手术治疗。术前并发症包括频繁腹痛，所有患者均有体重减轻，8例患者出现黄疸，8例和8例患者分别患有潜伏性和胰岛素依赖型糖尿病。通过内镜逆行胰胆管造影（ERCP）、超声检查和计算机断层扫描（CT）确诊。通过淀粉耐量试验（ATT）、葡萄糖耐量试验和粪便弹性蛋白酶检查胰腺功能。手术过程包括在胰头区域局部切除炎性肿瘤，不切断门静脉上方的胰腺。通过空肠Roux-en-Y袢将剩余胰腺的分泌物引流至肠道进行重建。在8例黄疸病例和12例胆总管狭窄患者中，还进行了乳头前胆管与空肠袢的吻合术。
仅因吻合口出血进行了一次再次手术，但术后及随访期间无死亡病例。住院时间为7至12天，中位数为8.5天。在中位随访期24个月（范围6至42个月）内，所有患者均无不适，体重平均增加10 kg（范围4 - 25 kg）。ATT和粪便弹性蛋白酶水平显示外分泌功能改善，术前内分泌功能无明显变化。
结果清楚地表明，这种保留器官的胰头切除术是一种安全有效的手术方法，可有效控制CP炎症改变后的并发症。
