Nealon W H, Townsend C M, Thompson J C
Department of Surgery, University of Texas Medical Branch, Galveston 77550.
Ann Surg. 1988 Sep;208(3):321-9. doi: 10.1097/00000658-198809000-00009.
In a prospective study, 85 patients with chronic pancreatitis have been subjected to evaluation by morphologic analysis (endoscopic retrograde cholangiopancreatography), by exocrine function tests (bentiromide PABA and 72-hour fecal fat testing), and by endocrine function tests (oral glucose tolerance test and fat-stimulated release of pancreatic polypeptide). All patients were graded on a five-point system, with 1 point assessed for an abnormal result in each of the five tests performed. Zero score denoted mild disease; 1-2 points signaled moderate disease; and 3-5 points indicated severe disease. In 68 patients, both an initial and late (mean follow-up period of 14 months) evaluation were performed. Forty-one patients underwent modified Puestow side-to-side Roux-en-Y pancreaticojejunostomy. The Puestow procedure alone was performed in 18 patients. Eight patients also had drainage of pseudocysts, seven also had a biliary bypass, and eight had pseudocyst drainage plus bypass, in addition to the Puestow. There were no deaths. Of the 68 patients who were studied twice, 30 had operations and 38 did not. None of the patients with severe disease improved their grade during follow-up. Of 24 patients who did not undergo operation, 17 (71%) who were graded mild/moderate progressed to a severe grade at follow-up. By contrast, only three of the 19 patients operated on (16%) and who were initially graded as mild/moderate progressed to severe disease at follow-up testing. More than 75% of all of the patients had a history of weight loss. Twenty-six of 30 patients operated on (87%) (all of whom had lost weight before surgery) gained a mean 4.2 kg (range 1.4-2.7 kg) after surgery, compared with no significant weight change (range -3.6-2.7 kg) among patients not operated on. These findings support a policy of early operation for chronic pancreatitis, perhaps even in the absence of disabling abdominal pain.
在一项前瞻性研究中，85例慢性胰腺炎患者接受了形态学分析（内镜逆行胰胆管造影）、外分泌功能测试（苯替酪胺对氨基苯甲酸试验和72小时粪便脂肪检测）以及内分泌功能测试（口服葡萄糖耐量试验和脂肪刺激的胰多肽释放试验）评估。所有患者按五分制分级，每项进行的五项测试中结果异常计1分。零分表示疾病较轻；1 - 2分表明疾病中等；3 - 5分意味着疾病严重。68例患者进行了初始和后期（平均随访期14个月）评估。41例患者接受了改良的普斯托侧侧吻合Roux-en-Y胰管空肠吻合术。仅进行普斯托手术的有18例患者。8例患者还进行了假性囊肿引流，7例还进行了胆肠吻合术，8例除普斯托手术外还进行了假性囊肿引流加吻合术。无死亡病例。在68例接受两次研究的患者中，30例接受了手术，38例未接受手术。所有重症患者在随访期间病情分级均未改善。在24例未接受手术的患者中，17例（71%）初始分级为轻/中度，随访时进展为重度。相比之下，19例接受手术且初始分级为轻/中度的患者中，随访测试时只有3例（16%）进展为重症。所有患者中超过75%有体重减轻史。30例接受手术的患者中有26例（87%）（所有患者术前均有体重减轻）术后平均体重增加4.2千克（范围1.4 - 2.7千克），而未接受手术的患者体重无显著变化（范围 - 3.6 - 2.7千克）。这些发现支持对慢性胰腺炎采取早期手术的策略，甚至在无致残性腹痛的情况下也可考虑手术。
