Carlin A, Fromm D
Department of Surgery, Wayne State University, Detroit, Michigan.
Surg Gynecol Obstet. 1993 Apr;176(4):315-8.
While pancreaticoduodenectomy is reported to be successful in certain patients with symptomatic recurrent or chronic pancreatitis, there are few criteria indicating who will benefit from such an extensive operation. This report consists of a small group of well-defined patients with recurrent episodes of alcoholic pancreatitis who benefited from pancreaticoduodenectomy. The courses of each patient were remarkably similar--recurrent episodes of pancreatitis, weight loss, epigastric pain, intermittent fevers, persistently elevated serum amylase and leukocyte counts, negative blood cultures, intermittent jaundice, failure of endoscopic retrograde cholangiopancreatography and scans showing a persistent mass in the head of the pancreas and biliary obstruction. While no patient had evidence of abscess at elective operation, all had multiple microscopic abscesses, apparently localized to the enlarged pancreatic head. Such localized microabscesses are not necessarily associated with acute clinical deterioration, positive blood cultures, cannulation of the pancreatic duct or pancreatic ductal dilatation. All patients benefited from operation. The presentation of recurrent episodes of pancreatitis associated with persistent enlargement of the pancreatic head and biliary obstruction without relentless progression of jaundice suggests that the patient will benefit from pancreaticoduodenectomy.
虽然据报道，胰十二指肠切除术在某些有症状的复发性或慢性胰腺炎患者中取得了成功，但几乎没有标准能表明谁将从这种大型手术中获益。本报告涵盖了一小群明确诊断为酒精性胰腺炎复发且从胰十二指肠切除术中获益的患者。每位患者的病程都非常相似——胰腺炎反复发作、体重减轻、上腹部疼痛、间歇性发热、血清淀粉酶和白细胞计数持续升高、血培养阴性、间歇性黄疸、内镜逆行胰胆管造影失败以及扫描显示胰腺头部有持续肿块和胆道梗阻。虽然在择期手术时没有患者有脓肿的证据，但所有患者都有多个微小脓肿，显然局限于肿大的胰头。这种局限性微小脓肿不一定与急性临床恶化、血培养阳性、胰管插管或胰管扩张有关。所有患者都从手术中获益。胰腺炎反复发作伴胰头持续肿大和胆道梗阻且黄疸无持续进展的表现提示患者将从胰十二指肠切除术中获益。
