Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin2Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Chicago, Illinois.
JAMA Surg. 2013 Nov;148(11):1057-62. doi: 10.1001/jamasurg.2013.3728.
Pancreas divisum is an uncommon congenital anomaly that may result in chronic pancreatitis (chronic pancreatitis secondary to pancreas divisum [CPPD]) and intractable pain. We evaluated the role of the Frey procedure in the management of patients with pain related to CPPD as compared with patients with chronic pancreatitis secondary to alcohol (CPA) or idiopathic causes (ICP).
To review our experience with the Frey procedure for the management of chronic pancreatitis related to pancreas divisum.
This was a 2-year institutional retrospective of patients undergoing the Frey procedure for chronic pancreatitis related-pain from April 2008 to June 2010.
Academic tertiary care referral center.
A consecutive sample of 14 patients undergoing the Frey procedure for chronic pancreatitis and disease-related intractable pain. We sought to examine the utility of the Frey procedure in patients with CPPD as compared with CPA and ICP.
The Frey procedure.
Perioperative outcomes and postoperative narcotic requirement were compared among patient groups.
Fourteen patients underwent the Frey procedure. The etiology of the disease was pancreas divisum in 6 patients, alcohol in 5, and idiopathic in 3. The most common indication for surgery was intractable pain, and all patients had undergone endoscopic retrograde cholangiopancreatography for attempted relief in the past. There were no statistically significant differences in median operative time (263 minutes), intraoperative blood loss (425 mL), median length of stay (9.5 days), or rate of morbidity (21%) between the 3 etiologies. Two-thirds of patients required less or no opioid at follow-up, although follow-up was significantly longer for CPPD and ICP than CPA (median, 249, 259, and 42 days, respectively; P < .02).
In this series, outcomes for patients with CPPD treated with the Frey procedure were equivalent to those treated for CPA. Patients with pancreas divisum and a dilated pancreatic duct may be ideally suited for this surgical strategy. The potential advantage of this approach over minor duct sphincteroplasty and lateral pancreaticojejunostomy is the removal of the fibrotic tissue of the head of the pancreas, thought to be the epicenter of pain in this condition. The benefits over resection alone include a more extensive ductal drainage procedure.
胰腺分裂是一种罕见的先天性异常，可能导致慢性胰腺炎（胰腺分裂继发的慢性胰腺炎[CPPD]）和难治性疼痛。我们评估了 Frey 手术在治疗与 CPPD 相关的疼痛患者中的作用，与酒精（CPA）或特发性病因（ICP）继发的慢性胰腺炎患者进行比较。
回顾我们使用 Frey 手术治疗胰腺分裂相关慢性胰腺炎的经验。
这是一项回顾性研究，对 2008 年 4 月至 2010 年 6 月期间接受 Frey 手术治疗与慢性胰腺炎相关疼痛的患者进行了为期 2 年的机构回顾。
学术三级转诊中心。
连续 14 例接受 Frey 手术治疗慢性胰腺炎和与疾病相关的难治性疼痛的患者。我们试图研究 Frey 手术在 CPPD 患者中的应用价值，并与 CPA 和 ICP 患者进行比较。
Frey 手术。
比较各组患者的围手术期结局和术后阿片类药物需求。
14 例患者接受了 Frey 手术。疾病的病因是 6 例胰腺分裂，5 例酒精，3 例特发性。手术最常见的指征是难治性疼痛，所有患者过去都曾接受过内镜逆行胰胆管造影以尝试缓解。在手术时间（263 分钟）、术中失血量（425 毫升）、中位住院时间（9.5 天）和发病率（21%）方面，3 种病因之间无统计学差异。三分之二的患者在随访时需要或不需要阿片类药物，但 CPPD 和 ICP 的随访时间明显长于 CPA（分别为中位 249、259 和 42 天；P <.02）。
在本系列中，CPPD 患者接受 Frey 手术的结果与接受 CPA 治疗的患者相当。患有胰腺分裂和扩张胰管的患者可能非常适合这种手术策略。与小的胰管括约肌切开术和胰管空肠吻合术相比，这种方法的潜在优势是切除胰腺头部的纤维组织，这被认为是这种疾病疼痛的中心。与单纯切除术相比，其优点包括更广泛的胰管引流手术。
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