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弗雷氏手术治疗慢性胰腺炎:短期结果

Frey procedure in the treatment of chronic pancreatitis: short-term results.

作者信息

Pessaux Patrick, Kianmanesh Reza, Regimbeau Jean-Marc, Sastre Bernard, Delcenserie Richard, Sielezneff Igor, Arnaud Jean-Pierre, Sauvanet Alain

机构信息

Department of Digestive Surgery, University Hospital, Angers, France.

出版信息

Pancreas. 2006 Nov;33(4):354-8. doi: 10.1097/01.mpa.0000236736.77359.3a.

Abstract

OBJECTIVE

The aim of this multicenter study was to report the short-term results of the Frey procedure in the treatment of chronic pancreatitis.

METHODS

For the period between September 2000 and January 2005, 34 Frey procedures were performed for chronic pancreatitis in 4 university hospitals. This study includes 31 men (91%) and 3 women (9%), with a mean age of 48 +/- 6 years (range, 32-58 years). The etiology of chronic pancreatitis was chronic alcohol ingestion in 32 patients (94%) and hereditary chronic pancreatitis in 2 patients. The indications of surgery were abdominal pain in all patients, requiring opiates in 59% (n = 20) and associated with a weight loss in 79% (n = 27).

RESULTS

There was no mortality. Eleven postoperative surgical complications occurred in 7 patients (20%). Three patients had a single complication, and 4 patients had 2 complications. Pancreatic fistula occurred in 4 patients and healed under conservative management in all cases. One patient had massive bleeding from the stump of gastroduodenal artery requiring reoperation. The mean hospital stay was 16 +/- 8 days (range, 9-40 days). The mean follow-up was 15 +/- 12 months (range, 3-37 months). At the time of the last follow-up visit, the examiner judged that 19 patients (56%) have complete pain relief and 11 patients (32%) have substantial pain relief. No patient used narcotic analgesics postoperatively. Seven patients developed diabetes mellitus, requiring insulin (n = 1), oral hypoglycemic agents (n = 5), and diet adjustment (n = 1). Four patients developed exocrine insufficiency. Weight increases with a mean of 4.8 +/- 5.4 kg (range, 1-24 kg) in 27 patients (79%).

CONCLUSIONS

Frey procedure appears as a safe technique with low mortality and morbidity rates and allows effective pain relief in about 90% of patients.

摘要

目的

本多中心研究旨在报告弗雷氏手术治疗慢性胰腺炎的短期结果。

方法

在2000年9月至2005年1月期间,4所大学医院对34例慢性胰腺炎患者实施了弗雷氏手术。本研究包括31名男性(91%)和3名女性(9%),平均年龄为48±6岁(范围32 - 58岁)。慢性胰腺炎的病因是32例患者(94%)长期饮酒,2例患者为遗传性慢性胰腺炎。所有患者的手术指征均为腹痛,其中59%(n = 20)的患者需要使用阿片类药物,79%(n = 27)的患者伴有体重减轻。

结果

无死亡病例。7例患者(20%)发生了11例术后手术并发症。3例患者有单一并发症,4例患者有2种并发症。4例患者发生胰瘘,均经保守治疗治愈。1例患者胃十二指肠动脉残端大量出血,需再次手术。平均住院时间为16±8天(范围9 - 40天)。平均随访时间为15±12个月(范围3 - 37个月)。在最后一次随访时,检查者判断19例患者(56%)疼痛完全缓解,11例患者(32%)疼痛明显缓解。术后无患者使用麻醉性镇痛药。7例患者发生糖尿病,其中1例需要胰岛素治疗,5例需要口服降糖药,1例需要调整饮食。4例患者出现外分泌功能不全。27例患者(79%)体重增加,平均增加4.8±5.4 kg(范围1 - 24 kg)。

结论

弗雷氏手术似乎是一种安全的技术,死亡率和发病率较低,约90%的患者疼痛能得到有效缓解。

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