Izbicki J R, Knoefel W T, Bloechle C, Küchler T, Kühn R, Limmer J C, Broelsch C E
Abteilung für Allgemeinchirurgie, Universitätskrankenhaus Eppendorf, Universität Hamburg.
Zentralbl Chir. 1995;120(4):298-305.
To evaluate the efficacy of duodenum-preserving resections of the head of the pancreas in the treatment of chronic pancreatitis this study was devised. So far studies on the natural course and the different therapeutic approaches have primarily focused on pain measurement in rough categories and hard data as mortality and morbidity. In this study the improvement of the quality of life was assessed to determine the therapeutic success of both procedures.
In a prospective randomized study 24 patients underwent either Beger's (n = 11) or Frey's procedure (n = 13) so far. 15 patients suffered from distal common bile duct stenosis, 2 from segmental duodenal stenosis, 4 from segmental portal hypertension, and one from pancreato-pleural fistula. The quality of life questionnaire of the European Organization for Research and Treatment of Cancer was assessed before surgery and during follow-up. The multidimensional questionnaire incorporates functional scales (physical, cognitive, emotional, and social), symptom scales (fatigue, pain, dyspnea, loss of appetite, sleep disturbance, obstipation, diarrhea, nausea, and vomiting), and a global quality of life scale. Follow-up was 12 months in all patients.
There was no postoperative mortality in neither group. Postoperative morbidity was 17% (n = 2 in either group). This included one transitory common bile duct stenosis, one bronchopneumonia, and two postoperative bleedings which were treated conservatively. The pain index was reduced by 94% in the Beger- and 90% in the Frey group. The physical status, working ability, emotional and social functioning, and global quality of life score had significantly improved by 46%, 50%, 69%, 60%, and 67% in the Beger group and by 38%, 50%, 64%, 80%, and 67% in the Frey group.
The duodenum-preserving resections of the head of the pancreas according to Beger and Frey are equivalently safe and effective. Both techniques result in a significant improvement of the patients' quality of life.
为评估保留十二指肠的胰头切除术治疗慢性胰腺炎的疗效而设计了本研究。迄今为止，关于自然病程和不同治疗方法的研究主要集中在粗略分类的疼痛测量以及死亡率和发病率等硬数据上。在本研究中，评估了生活质量的改善情况以确定两种手术方法的治疗成功率。
在一项前瞻性随机研究中，目前有24例患者接受了贝格尔手术（n = 11）或弗雷手术（n = 13）。15例患者患有远端胆总管狭窄，2例患有节段性十二指肠狭窄，4例患有节段性门静脉高压，1例患有胰胸膜瘘。在手术前和随访期间评估了欧洲癌症研究与治疗组织的生活质量问卷。该多维问卷包括功能量表（身体、认知、情感和社会）、症状量表（疲劳、疼痛、呼吸困难、食欲不振、睡眠障碍、便秘、腹泻、恶心和呕吐）以及总体生活质量量表。所有患者的随访时间为12个月。
两组均无术后死亡病例。术后发病率为17%（每组n = 2）。这包括1例暂时性胆总管狭窄、1例支气管肺炎和2例术后出血，均采用保守治疗。贝格尔组的疼痛指数降低了94%，弗雷组降低了90%。贝格尔组的身体状况、工作能力、情感和社会功能以及总体生活质量评分分别显著提高了46%、50%、69%、60%和67%，弗雷组分别提高了38%、50%、64%、80%和67%。
根据贝格尔和弗雷方法进行的保留十二指肠的胰头切除术同样安全有效。两种技术均能显著改善患者的生活质量。
