From the Department of General Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Ann Surg. 2013 Nov;258(5):815-20; discussion 820-1. doi: 10.1097/SLA.0b013e3182a655a8.
The aim of this study was to report on 15-year long-term results of a randomized controlled trial comparing extended drainage procedure (Frey) and classical resectional procedure [pylorus-preserving pancreatoduodenectomy (PD)] in patients with chronic pancreatitis.
Chronic pancreatitis is a common inflammatory disease with a prevalence of 10 to 30 cases per 100,000 inhabitants. It is characterized by the progressive conversion of pancreatic parenchyma to fibrous tissue. Different surgical procedures are used in treatment of persistent pain.
Sixty-four patients suffering from chronic pancreatitis with inflammatory mass in the pancreatic head were randomly assigned in 2 treatment groups (PD, n = 32) and (Frey, n = 32). The perioperative course of the randomized controlled trial and the 7 years follow-up have been previously published. All participating patients were contacted with a standardized, validated questionnaire (EORTC QLQ C30) to evaluate the long-term survival, quality-of-life pain, and exocrine and endocrine function.
In the 15-year long-term follow-up, the pain control was good and comparable between both groups, but the quality of life was better after Frey procedure in regard of the physical status [PD: 100 (0-100) vs PD: 60 (0-100) (P = 0.011)]. No significant differences in terms of the Pain Score were detected between both groups [PD: 7 (0-100) vs Frey 4 (0-100) P = 0.258]. Seven patients after Frey OP and 6 patients after PD were free of pain. Analyzing the postoperative overall survival, a higher long-term mortality was found after PD (53%) than that found after Frey procedure (30%) resulting in a longer mean survival (14.5 ± 0.8 vs 11.3 ± 0.8 years; P = 0.037). No correlation between endocrine or exocrine pancreatic function and pain was found, whereas continuous alcohol consumption was associated with poorer outcome regarding quality of life (P < 0.001) and pain score (P < 0.001).
PD and Frey procedure provide good and permanent pain relief and improvement of the quality of life in long-term follow-up. In addition, a longer survival was found after the organ sparing resection. Together with better short-term results, the organ-sparing procedure seems to be favorable in treatment of chronic pancreatitis.
本研究旨在报告一项比较慢性胰腺炎患者行胰十二指肠保留幽门切除术（PD）和经典切除术（保留胰管的胰切除术（Frey））的 15 年长期随机对照试验结果。
慢性胰腺炎是一种常见的炎症性疾病，发病率为每 10 万居民中有 10 至 30 例。其特征是胰腺实质逐渐转化为纤维组织。不同的手术程序用于治疗持续性疼痛。
64 例患有慢性胰腺炎伴胰头部炎性肿块的患者随机分为 2 个治疗组（PD，n=32）和（Frey，n=32）。随机对照试验的围手术期和 7 年随访已在之前发表。所有参与的患者均通过标准化、经过验证的问卷（EORTC QLQ C30）进行联系，以评估长期生存、生活质量疼痛、外分泌和内分泌功能。
在 15 年的长期随访中，两组的疼痛控制均良好且相当，但 Frey 手术后的生活质量更好，在身体状况方面[PD：100（0-100）比 PD：60（0-100）（P=0.011）]。两组之间的疼痛评分无显著差异[PD：7（0-100）比 Frey 4（0-100）（P=0.258）]。 Frey 手术后 7 例和 PD 手术后 6 例患者无疼痛。分析术后总体生存率，PD 后发现长期死亡率较高（53%），Frey 手术后死亡率较低（30%），导致平均生存时间较长（14.5±0.8 比 11.3±0.8 年；P=0.037）。未发现外分泌或内分泌胰腺功能与疼痛之间存在相关性，而持续饮酒与生活质量（P<0.001）和疼痛评分（P<0.001）较差有关。
PD 和 Frey 手术在长期随访中提供了良好且持久的疼痛缓解和生活质量改善。此外，在保留器官的切除术后发现了更长的生存时间。结合更好的短期结果，保留器官的手术似乎有利于慢性胰腺炎的治疗。
