Izbicki J R, Bloechle C, Knoefel W T, Kuechler T, Binmoeller K F, Broelsch C E
Department of Surgery, University of Hamburg, Germany.
Ann Surg. 1995 Apr;221(4):350-8. doi: 10.1097/00000658-199504000-00004.
Two techniques of duodenum-preserving resection of the head of the pancreas were compared in a prospective, randomized trial. The technical feasibility and effects on quality of life were assessed.
Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Berger and Frey combine both to different degrees. The efficacy of both procedures has not been compared thus far.
Forty-two patients were allocated randomly to either Beger's (n = 20) or Frey's (n = 22) group. In addition to routine pancreatic diagnostic work-up, a multidimensional psychometric quality-of-life questionnaire and and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The interval between symptoms and surgery ranged from 12 months to 12 years, with a mean of 5.7 years. The mean follow-up was 1.5 years.
There was no mortality. Overall morbidity was 14% (20% Beger, 9% Frey). Complications from adjacent organs were resolved definitively in 94% (90% Beger, 100% Frey). A decrease of 95% and 94% of the pain score after Beger's and Frey's procedure, respectively, and an increase of 67% of the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between both groups.
Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and definitive control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.
在一项前瞻性随机试验中比较两种保留十二指肠的胰头切除术技术。评估其技术可行性及对生活质量的影响。
引流和切除是慢性胰腺炎手术的原则。Berger和Frey所描述的保留十二指肠的胰头切除术技术在不同程度上结合了这两者。到目前为止，这两种手术的疗效尚未进行比较。
42例患者被随机分配至Beger组（n = 20）或Frey组（n = 22）。除了常规的胰腺诊断检查外，还使用了多维心理测量生活质量问卷和疼痛评分。内分泌和外分泌功能评估包括口服葡萄糖耐量试验、胰岛素、C肽和糖化血红蛋白的血清浓度，以及粪便糜蛋白酶和胰月桂基试验。症状出现至手术的间隔时间为12个月至12年，平均为5.7年。平均随访时间为1.5年。
无死亡病例。总体发病率为14%（Beger组为20%，Frey组为9%）。94%的相邻器官并发症得到彻底解决（Beger组为90%，Frey组为100%）。观察到Beger手术和Frey手术后疼痛评分分别降低了95%和94%，两组的总体生活质量指数均提高了67%。两组的内分泌和外分泌功能无差异。
在缓解疼痛、改善生活质量以及对影响相邻器官的并发症进行彻底控制方面，两种保留十二指肠的胰头切除术技术同样安全有效。两种手术均不会导致胰腺内分泌和外分泌功能进一步恶化。
