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胰头大小正常且胰管扩张的慢性胰腺炎的外科治疗：Frey术式还是改良Partington术式？

Surgical Treatment for Chronic Pancreatitis With a Normal-Sized Pancreatic Head and a Dilated Duct: Frey or Extended Partington Procedure?

作者信息

Mai Dai Nga, Nguyen Quoc Vinh, Phan Minh Tri, Doan Tien My

机构信息

Hepatobiliary and Pancreatic Surgery, Cho Ray Hospital, Ho Chi Minh, VNM.

Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM.

出版信息

Cureus. 2024 Jun 7;16(6):e61881. doi: 10.7759/cureus.61881. eCollection 2024 Jun.

DOI:10.7759/cureus.61881
PMID:38855486
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11162353/
Abstract

BACKGROUND

Surgical drainage for chronic pancreatitis patients with a normal-sized pancreatic head remains controversial. Both Frey and extended Partington procedures could be used, but the level of evidence is weak.

METHOD

The object of this prospective cohort study was to assess the mid-term results concerning pain, quality of life, and pancreatic function of surgical drainage (Frey or extended Partington procedure) in patients with painful chronic pancreatitis and a normal-sized pancreatic head.

RESULTS

Fifty-nine patients (Frey procedure: 14 cases; extended Partington procedure: 45 cases) were enrolled in the study with a median length of follow-up of 16 months. The effective and complete pain relief rate was 85% and 58%, respectively. The Izbicki score decreased from 53.4 preoperatively to 8.8 postoperatively. The general 12-Item Short Form Health Survey (SF-12) score increased from 45.2 to 75.4. The pancreatic insufficiency did not change significantly postoperatively. At three months after surgery, the complete pain relief and Izbicki score were more favorable in the Frey group than in the extended Partington group.

CONCLUSION

Both Frey and extended Partington procedures resulted in excellent pain relief and quality of life improvement and did not worsen pancreatic function. The Frey procedure could yield a more favorable result in the early postoperative period.

摘要

背景

对于胰头大小正常的慢性胰腺炎患者，手术引流仍存在争议。Frey手术和改良Partington手术均可采用，但证据水平较弱。

方法

这项前瞻性队列研究的目的是评估采用手术引流（Frey手术或改良Partington手术）治疗疼痛性慢性胰腺炎且胰头大小正常的患者在疼痛、生活质量和胰腺功能方面的中期结果。

结果

59例患者纳入研究（Frey手术：14例；改良Partington手术：45例），中位随访时间为16个月。有效和完全疼痛缓解率分别为85%和58%。Izbicki评分从术前的53.4降至术后的8.8。一般12项简明健康调查（SF-12）评分从45.2提高到75.4。术后胰腺功能不全无明显变化。术后3个月，Frey组的完全疼痛缓解情况和Izbicki评分优于改良Partington组。

结论

Frey手术和改良Partington手术均能有效缓解疼痛，改善生活质量，且不恶化胰腺功能。Frey手术在术后早期可能产生更有利的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/7eaeb00147a6/cureus-0016-00000061881-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/728f61332aab/cureus-0016-00000061881-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/cce0f6206a02/cureus-0016-00000061881-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/83d1722876df/cureus-0016-00000061881-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/7eaeb00147a6/cureus-0016-00000061881-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/728f61332aab/cureus-0016-00000061881-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/cce0f6206a02/cureus-0016-00000061881-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/83d1722876df/cureus-0016-00000061881-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf76/11162353/7eaeb00147a6/cureus-0016-00000061881-i04.jpg

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本文引用的文献

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Short- and long-term outcomes of selective use of Frey or extended lateral pancreaticojejunostomy in chronic pancreatitis.慢性胰腺炎中选择性使用 Frey 或扩大的胰管空肠吻合术的短期和长期结果。
Br J Surg. 2022 Mar 15;109(4):363-371. doi: 10.1093/bjs/znab473.
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Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence.胰脏炎的帕丁顿手术是否已成为过去？对证据的回顾。
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