Izbicki J R, Bloechle C, Knoefel W T, Wilker D K, Dornschneider G, Seifert H, Passlick B, Rogiers X, Busch C, Broelsch C E
Department of Surgery, Universitäts-Krankenhaus Eppendorf, University of Hamburg, Germany.
Br J Surg. 1994 Sep;81(9):1351-5. doi: 10.1002/bjs.1800810932.
Chronic pancreatitis frequently generates complications through involvement of adjacent organs. Distal common bile duct stenosis and segmental duodenal stenosis, the most frequent complications, are usually treated by resection or bypass procedures. This study presents experience with duodenum-preserving resection of the head of the pancreas in the treatment of patients with chronic pancreatitis with predominant involvement of the pancreatic head and coexisting complications involving adjacent organs. This procedure preserves the structure and function of the bile duct and duodenum. Sixty-six patients with severe chronic pancreatitis underwent duodenum-preserving resection of the head of the pancreas. Thirty-eight had associated complications of neighbouring organs: 37 had distal common bile duct stenosis, seven had duodenal stenosis, ten had evidence of segmental portal hypertension and one suffered from a pancreatopleural fistula. Details of all patients were documented prospectively; mean follow-up was 4.2 years. The complications of adjacent organs were permanently eradicated in 36 of 38 patients. Two patients required endoscopic stenting for persisting bile duct obstruction. There was substantial or complete relief of all symptoms in 35 patients. Duodenum-preserving resection of the head of the pancreas is effective in the treatment of severe chronic pancreatitis with predominant involvement of the pancreatic head and provides definitive management of associated complications of adjacent organs.
慢性胰腺炎常因累及邻近器官而引发并发症。远端胆总管狭窄和节段性十二指肠狭窄是最常见的并发症，通常采用切除或旁路手术治疗。本研究介绍了保留十二指肠的胰头切除术治疗以胰头为主受累且伴有邻近器官并发症的慢性胰腺炎患者的经验。该手术保留了胆管和十二指肠的结构与功能。66例重症慢性胰腺炎患者接受了保留十二指肠的胰头切除术。38例伴有邻近器官并发症：37例有远端胆总管狭窄，7例有十二指肠狭窄，10例有节段性门静脉高压迹象，1例患有胰胸膜瘘。所有患者的详细情况均进行了前瞻性记录；平均随访4.2年。38例患者中的36例邻近器官并发症得到永久性根除。2例患者因持续性胆管梗阻需要内镜支架置入。35例患者的所有症状得到显著缓解或完全缓解。保留十二指肠的胰头切除术对以胰头为主受累的重症慢性胰腺炎有效，并能对邻近器官的相关并发症提供确定性治疗。
