University of Schleswig-Holstein, Department of Surgery, 23538 Lübeck, Germany.
Eur J Med Res. 2010 Aug 20;15(8):351-6. doi: 10.1186/2047-783x-15-8-351.
In general, chronic pancreatitis (CP) primarily requires conservative treatment. The chronic pain syndrome and complications make patients seek surgical advice, frequently after years of progression. In the past, surgical procedures involving drainage as well as resection have been employed successfully. The present study compared the different surgical strategies. -
From March 2000 until April 2005, a total of 51 patients underwent surgical treatment for CP at the Department of surgery, University of Schleswig-Holstein, Campus Lübeck. Out of those 51 patients, 39 (76.5%) were operated according to the Frey procedure, and in 12 cases (23.5%) the Whipple procedure was performed. Patient data were documented prospectively throughout the duration of the hospital stay. The evaluation of the postoperative pain score was carried out retrospectively with a validated questionnaire.
Average operating time was 240 minutes for the Frey group and 411 minutes for the Whipple group. The medium number of blood transfusions was 1 in the Frey group and 4.5 in the Whipple group. Overall morbidity was 21% in the Frey group and 42% in the Whipple group. 30-day mortality was zero for all patients. During the median follow-up period of 50 months, an improvement in pain score was observed in 93% of the patients of the Frey group and 67% of the patients treated according to the Whipple procedure.
The results show that both the Frey procedure as well as partial pancreaticoduodenectomy are capable of improving chronic pain symptoms in CP. As far as later endocrine and exocrine pancreatic insufficiency is concerned, however, the extended drainage operation according to Frey proves to be advantageous compared to the traditional resection procedure by Whipple. Accordingly, the Frey procedure provides us with an organ-preserving surgical procedure which treats the complications of CP sufficiently, thus being an alternative to partial pancreaticoduodenectomy if there is no suspicion of malignancy.
一般来说，慢性胰腺炎（CP）主要需要保守治疗。慢性疼痛综合征和并发症使患者寻求手术建议，通常在多年进展后。过去，引流和切除术等手术程序已成功实施。本研究比较了不同的手术策略。
2000 年 3 月至 2005 年 4 月，石勒苏益格-荷尔斯泰因大学吕贝克校区外科系共对 51 例 CP 患者进行了手术治疗。在这 51 例患者中，有 39 例（76.5%）按 Frey 手术治疗，12 例（23.5%）行 Whipple 手术。患者数据在整个住院期间进行前瞻性记录。术后疼痛评分的评估采用经过验证的问卷进行回顾性评估。
Frey 组的平均手术时间为 240 分钟，Whipple 组为 411 分钟。Frey 组平均输血 1 单位，Whipple 组输血 4.5 单位。Frey 组总体发病率为 21%，Whipple 组为 42%。所有患者的 30 天死亡率均为零。在 50 个月的中位随访期间，Frey 组 93%的患者和 Whipple 组 67%的患者疼痛评分有所改善。
结果表明，Frey 手术和部分胰十二指肠切除术均能改善 CP 的慢性疼痛症状。就晚期内分泌和外分泌胰腺功能不全而言，根据 Frey 进行的扩展引流手术比传统的 Whipple 切除术具有优势。因此，Frey 手术为我们提供了一种保留器官的手术方法，足以治疗 CP 的并发症，如果没有恶性肿瘤的怀疑，它可以替代部分胰十二指肠切除术。
