Cooper M J, Williamson R C
Br J Surg. 1984 Oct;71(10):761-6. doi: 10.1002/bjs.1800711008.
If pancreatic ductal hypertension explained the pain of chronic pancreatitis, adequate decompression of ectatic ducts should provide lasting relief. We have analysed a personal series of 20 patients (14 men and 6 women) with chronic pancreatitis undergoing one or more drainage procedures. Alcohol was the main aetiological factor, and symptoms had been present for a median of 2.5 years. Pancreatic ductal decompression was achieved by pancreatic sphincteroplasty (n = 4) or longitudinal pancreaticojejunostomy (11). Thirteen patients underwent incidental or additional procedures to decompress the biliary tree: sphincteroplasty (5), choledochal bypass (7) and T-tube drainage (1). Cysts were either drained (7) or resected (3). Two patients required re-operation for subphrenic abscess. Some pancreatic insufficiency was detected preoperatively in 11 patients (exocrine 10, endocrine 4) and was essentially unchanged in all but one patient who came to total pancreatectomy. Two other patients required a coeliac plexus block, but the remaining 17 patients had good pain relief at a median follow-up of 30 months. Ductal drainage procedures effectively relieve the pain of chronic pancreatitis without further compromising pancreatic function.
如果胰腺导管高压可以解释慢性胰腺炎的疼痛，那么扩张导管的充分减压应能提供持久缓解。我们分析了一组20例慢性胰腺炎患者（14例男性和6例女性）的个人病例系列，这些患者接受了一次或多次引流手术。酒精是主要病因，症状出现的中位时间为2.5年。通过胰腺括约肌成形术（n = 4）或胰管空肠吻合术（11例）实现胰腺导管减压。13例患者接受了偶然或额外的手术以减压胆管树：括约肌成形术（5例）、胆总管旁路术（7例）和T管引流（1例）。囊肿要么引流（7例）要么切除（3例）。2例患者因膈下脓肿需要再次手术。术前在11例患者中检测到一些胰腺功能不全（外分泌功能不全10例，内分泌功能不全4例），除1例接受全胰切除术的患者外，其他患者的胰腺功能基本未变。另外2例患者需要进行腹腔神经丛阻滞，但其余17例患者在中位随访30个月时疼痛得到良好缓解。导管引流手术可有效缓解慢性胰腺炎的疼痛，且不会进一步损害胰腺功能。
