Tan Chun-Lu, Zhang Hao, Li Ke-Zhou
Chun-Lu Tan, Hao Zhang, Ke-Zhou Li, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2015 Nov 28;21(44):12644-52. doi: 10.3748/wjg.v21.i44.12644.
To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis (CP) and patient selection.
All consecutive patients undergoing duodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index (BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index (white blood cells, interleukin (IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data (postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.
Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male (85%) and seven were female (16%). The etiology of CP was alcohol in 32 patients (70%) and idiopathic in 14 patients (30%). Stones were found in 38 patients (83%). An inflammatory mass was found in five patients (11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19 (9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7 (17.8-22.4) kg/m(2) and was 20.6 ± 2.9 (15.4-27.7) kg/m(2) in the open group. All patients required analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients (43%). Pre-operative complications due to pancreatitis were observed in 18 patients (39%). Pancreatic functional insufficiency was observed in 14 patients (30%). Two laparoscopic patients (2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29 (290-370) min. Estimated intra-operative blood loss was 57 ± 14 (40-80) mL. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2 (5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass (P < 0.001) and acute exacerbation (P < 0.001) were risk factors for intra-operative blood loss.
The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.
分享我们关于慢性胰腺炎（CP）的腹腔镜 Frey 手术及患者选择的经验。
回顾 2013 年 7 月至 2014 年 7 月期间所有接受保留十二指肠的胰头切除术的连续患者，将接受 Frey 手术治疗 CP 的患者纳入本研究。获取接受腹腔镜手术患者的年龄、性别、体重指数（BMI）、美国麻醉医师协会评分、影像学检查结果、炎症指标（白细胞、白细胞介素（IL）-6 和 C 反应蛋白）、住院期间及门诊就诊时的视觉模拟评分、CP 病史、手术时间、估计失血量以及术后数据（术后死亡率和发病率、术后住院时间）。对本研究中的开放手术病例分析与大量出血相关的危险因素，大量出血是腹腔镜手术中转开腹的主要原因。评估这些患者的年龄、性别、病因、影像学检查结果、淀粉酶水平、胰腺炎相关并发症、功能不全以及 CP 病史。
分析了 9 例腹腔镜 Frey 手术和 37 例开放 Frey 手术。46 例患者中，39 例为男性（85%），7 例为女性（16%）。CP 的病因中，32 例（70%）为酒精性，14 例（30%）为特发性。38 例（83%）患者发现结石。5 例（11%）患者发现炎性肿块。从 CP 诊断到 Frey 手术的时间为 39±19（9 - 85）个月。腹腔镜组患者的 BMI 为 20.4±1.7（17.8 - 22.4）kg/m²，开放组为 20.6±2.9（15.4 - 27.7）kg/m²。所有患者均需使用镇痛药缓解腹痛。20 例（43%）患者频繁发生急性胰腺炎或因急性加重出现严重腹痛。18 例（39%）患者术前出现胰腺炎相关并发症。14 例（30%）患者出现胰腺功能不全。2 例腹腔镜手术患者（2/9）中转开腹。7 例成功的腹腔镜手术病例中，平均手术时间为 323±29（290 - 370）分钟。估计术中失血量为 57±14（40 - 80）毫升。1 例患者出现术后并发症，未观察到死亡病例。术后住院时间为 7±2（5 - 11）天。对 37 例开放 Frey 手术进行多元线性回归分析显示，炎性肿块（P < 0.001）和急性加重（P < 0.001）是术中失血的危险因素。
CP 的腹腔镜 Frey 手术可行，但仅适用于经过精心挑选的患者。
