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慢性胰腺炎合并胆道梗阻、门静脉狭窄及肠系膜静脉侧支循环患者的顽固性疼痛手术治疗。

Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction, portal vein stenosis and mesenteric venous collaterals.

作者信息

Kayaalp Cuneyt, Dogan Murat Sait, Ersan Veysel

机构信息

Department of Surgery, Inonu University, Malatya, Turkey.

出版信息

Ann Hepatobiliary Pancreat Surg. 2017 May;21(2):101-105. doi: 10.14701/ahbps.2017.21.2.101. Epub 2017 May 23.

DOI:10.14701/ahbps.2017.21.2.101
PMID:28567456
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5449365/
Abstract

Pancreatic head resection for chronic pancreatitis is a challenging procedure, in the presence of venous collaterals, cavernous transformation, extensive fibrosis or porto-mesenteric stenosis or thrombosis. We present a surgically treated patient for the intractable pain of chronic pancreatitis. Complications with biliary obstruction and portal vein stenosis/thrombosis resulted in cavernous transformation. A pancreaticoduodenectomy combined with portal vein resection was intended in a 51 year-old male, but the procedure was terminated due to the high risk associated with intraoperative bleeding. The surgical procedure was switched to a Frey procedure, wherein partial pancreatic head resection, drainage of the pancreatic canal and sufficient pain palliation, without an increased risk of intraoperative hemorrhage, was ensured. The procedure was successfully combined with bilio-enteric anastomosis.

摘要

对于存在静脉侧支循环、海绵样变性、广泛纤维化或门静脉肠系膜狭窄或血栓形成的慢性胰腺炎患者，胰头切除术是一项具有挑战性的手术。我们报告一例因慢性胰腺炎顽固性疼痛接受手术治疗的患者。该患者出现了胆管梗阻和门静脉狭窄/血栓形成等并发症，导致了海绵样变性。一名51岁男性患者原计划行胰十二指肠切除术联合门静脉切除术，但由于术中出血风险高，手术终止。手术改为Frey手术，该手术确保了部分胰头切除、胰管引流和充分的疼痛缓解，且未增加术中出血风险。该手术成功地与胆肠吻合术相结合。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/ea36a6b5d6a3/ahbps-21-101-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/f6f03d71ddce/ahbps-21-101-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/540d541c2a36/ahbps-21-101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/4fffb6216acc/ahbps-21-101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/565a4f439902/ahbps-21-101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/af052e38c707/ahbps-21-101-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/f584c634a60e/ahbps-21-101-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/ea36a6b5d6a3/ahbps-21-101-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/f6f03d71ddce/ahbps-21-101-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/0483971e7c70/ahbps-21-101-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/540d541c2a36/ahbps-21-101-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/4fffb6216acc/ahbps-21-101-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/565a4f439902/ahbps-21-101-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/af052e38c707/ahbps-21-101-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/f584c634a60e/ahbps-21-101-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7798/5449365/ea36a6b5d6a3/ahbps-21-101-g008.jpg

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本文引用的文献

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Chronic pancreatitis.慢性胰腺炎。
Lancet. 2016 May 7;387(10031):1957-66. doi: 10.1016/S0140-6736(16)00097-0. Epub 2016 Mar 2.
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Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis.保留十二指肠的胰腺切除术与胰十二指肠切除术治疗慢性胰腺炎的对比
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