Frick S, Ebert M, Rückert K
Dtsch Med Wochenschr. 1987 May 22;112(21):832-7. doi: 10.1055/s-2008-1068149.
Between 1966 and 1985, 994 patients with chronic pancreatitis were treated at a University Surgical Department, 346 by drainage or diversion procedure, 339 by resection and 309 conservatively. The most frequent non-resecting procedures were: pancreatic pseudocyst drainage in 146, biliary-digestive tract anastomosis in 80, gastro-enterostomy in 15, biliary-tract revision in 58 and pancreatic duct drainage in 7 patients. More than half the patients had previously been operated on at least once. Overall postoperative death rate was 6.6%. Of those operated on up to 1983, whose subsequent course was analysed retrospectively, 16% had died (mean observation period 4.6 years). As many as 29% of patients had further bouts of pancreatitis. Weight remained steady or increased in 82%, the number of those with diabetes increased by 6%. All but 12% remained free of pain postoperatively or had only minor and occasional symptoms. Alcohol abuse decreased markedly. If alcohol consumption remained moderate (less than 50 g daily), late mortality rate was definitely decreased. Drainage or diversion procedures and pancreas resection are not competitive but complementary methods in chronic pancreatitis. Imaging techniques have helped the trend towards more conservative management.
1966年至1985年间，一所大学外科对994例慢性胰腺炎患者进行了治疗，其中346例行引流或改道术，339例行切除术，309例采用保守治疗。最常见的非切除手术包括：146例胰腺假性囊肿引流术、80例胆-消化道吻合术、15例胃肠吻合术、58例胆道修复术以及7例胰管引流术。超过半数的患者此前至少接受过一次手术。总体术后死亡率为6.6%。对1983年以前接受手术且随后病程进行回顾性分析的患者而言，16%已经死亡（平均观察期4.6年）。多达29%的患者胰腺炎复发。82%的患者体重保持稳定或增加，糖尿病患者数量增加了6%。除12%的患者外，所有患者术后均无疼痛或仅有轻微及偶尔的症状。酗酒明显减少。如果饮酒量保持适度（每日少于50克），晚期死亡率肯定会降低。引流或改道术与胰腺切除术在慢性胰腺炎治疗中并非相互竞争而是相辅相成的方法。成像技术推动了治疗向更保守方向发展的趋势。
