Prinz R A, Aranha G V, Greenlee H B
Arch Surg. 1985 Mar;120(3):361-6. doi: 10.1001/archsurg.1985.01390270099017.
In 55 patients undergoing pancreaticojejunostomy for intractable abdominal pain, common bile duct obstruction occurred in 29% (16/55) and duodenal obstruction occurred in 15% (8/55). Serum alkaline phosphatase and total and direct serum bilirubin levels were significantly higher in patients with intrapancreatic common bile duct stenosis. Transient upper gastrointestinal (UGI) tract obstruction was common with chronic pancreatitis; however, if symptoms persisted beyond 2 weeks, fixed duodenal obstruction was likely. Endoscopic retrograde cholangiopancreatography and UGI roentgenograms and endoscopy were useful in confirming mechanical obstruction to the biliary and UGI tracts, respectively. There was no difference in operative mortality and morbidity from combined drainage procedures compared with pancreaticojejunostomy alone. The biliary and UGI tracts should be investigated in symptomatic patients both before and after pancreaticojejunostomy. Combined drainage of the pancreatic duct and UGI and biliary tract is safe and effective treatment for obstructing complications of chronic pancreatitis.
在55例因顽固性腹痛接受胰空肠吻合术的患者中，29%（16/55）发生胆总管梗阻，15%（8/55）发生十二指肠梗阻。胰内胆总管狭窄患者的血清碱性磷酸酶、血清总胆红素和直接胆红素水平显著更高。慢性胰腺炎患者常出现短暂的上消化道（UGI）梗阻；然而，如果症状持续超过2周，则可能存在固定性十二指肠梗阻。内镜逆行胰胆管造影、UGI X线片和内镜检查分别有助于确认胆道和UGI的机械性梗阻。与单纯胰空肠吻合术相比，联合引流手术的手术死亡率和发病率没有差异。对于有症状的患者，在胰空肠吻合术前和术后都应检查胆道和UGI。胰管与UGI及胆道联合引流是治疗慢性胰腺炎梗阻性并发症的安全有效方法。
