Eckhauser F E, Strodel W E, Knol J A, Harper M, Turcotte J G
Surgery. 1984 Oct;96(4):599-607.
Eighty-seven patients underwent distal subtotal or near-total (80% to 95%) pancreatectomy (NTP) during a 25-year period for management of intractable pain resulting from chronic pancreatitis. Alcoholism affected the majority of patients and 20% of cases were idiopathic in origin. Ten patients (12%) exhibited insulin-requiring diabetes before operation. The perioperative mortality rate was 3.4%. Significant improvement or complete pain relief was achieved in 75% of patients while 14% remained narcotic dependent. Forty-four patients (51%) required insulin postoperatively, with an average insulin requirement of 35 U per day. Thirty late deaths occurred 2 to 15 years after operation, 12 (40%) of which were related to complications of pancreatic insufficiency or persistent alcoholism. Five patients (8.5%) required completion pancreatectomy 6 months to 4 years after NTP for complications relating to persistent pancreatitis. NTP provides effective pain relief in the majority of patients with chronic pancreatitis. While this procedure can be performed with a low operative mortality rate, the high incidence of endocrine and exocrine insufficiency after operation may contribute to late deaths. Consequently, this procedure should be performed only when the underlying disease has functionally destroyed the pancreas or when lesser procedures have failed to provide adequate pain relief.
在25年期间，87例患者接受了远端次全或近全（80%至95%）胰腺切除术（NTP），以治疗慢性胰腺炎引起的顽固性疼痛。大多数患者受酒精中毒影响，20%的病例病因不明。10例患者（12%）术前表现为需胰岛素治疗的糖尿病。围手术期死亡率为3.4%。75%的患者疼痛得到显著改善或完全缓解，而14%的患者仍依赖麻醉剂。44例患者（51%）术后需要胰岛素，平均每日胰岛素需求量为35单位。术后2至15年发生30例晚期死亡，其中12例（40%）与胰腺功能不全或持续酗酒的并发症有关。5例患者（8.5%）在NTP术后6个月至4年因持续性胰腺炎相关并发症需要行全胰腺切除术。NTP能使大多数慢性胰腺炎患者的疼痛得到有效缓解。虽然该手术的手术死亡率较低，但术后内分泌和外分泌功能不全的发生率较高，可能导致晚期死亡。因此，仅当基础疾病已在功能上破坏胰腺或较小的手术未能提供充分的疼痛缓解时，才应进行该手术。
