Rattner D W, Fernandez-del Castillo C, Warshaw A L
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
Am J Surg. 1996 Jan;171(1):142-5; discussion 145-6. doi: 10.1016/s0002-9610(99)80089-0.
To examine whether preoperative computed tomography (CT) scans and pancreatograms can: (1) identify patients with chronic pancreatitis localized to the tail of the pancreas; and (2) select those patients who can obtain pain relief from a distal pancreatectomy.
Twenty patients were identified on whom the authors had performed distal pancreatectomy for relief of pain between January 1, 1991 and August 1, 1994. The results of surgery were classified as good, fair, or poor based on return to work and need for narcotics or rehospitalization.
Eleven patients had good, 3 fair, and 6 poor results. All 7 patients with pseudocysts of the tail of the pancreas had good results, while 9 of 13 patients without pseudocysts had poor results. No other finding on CT scan, pancreatography, or laparotomy predicted successful pain relief by distal pancreatectomy. Furthermore, 3 patients had unexpected carcinoma found at the time of surgery.
Even when anatomic evidence suggests that chronic pancreatitis primarily involves the tail of the pancreas and there is a stricture of the midpancreatic duct that is believed to cause the symptoms, distal pancreatectomy seldom provides sustained pain relief. Unsuspected carcinoma of the body and tail of the pancreas occurs frequently in this subset of patients with chronic pancreatitis.
探讨术前计算机断层扫描（CT）和胰管造影能否：（1）识别胰腺尾部局限性慢性胰腺炎患者；（2）挑选出能通过胰体尾切除术缓解疼痛的患者。
确定了20例在1991年1月1日至1994年8月1日期间接受胰体尾切除术以缓解疼痛的患者。根据恢复工作情况以及对麻醉药品的需求或再次住院情况，将手术结果分为良好、一般或差。
11例患者结果良好，3例一般，6例差。所有7例胰腺尾部假性囊肿患者结果良好，而13例无假性囊肿的患者中有9例结果差。CT扫描、胰管造影或剖腹手术的其他检查结果均无法预测胰体尾切除术能否成功缓解疼痛。此外，3例患者在手术时意外发现了癌。
即使解剖学证据表明慢性胰腺炎主要累及胰腺尾部，且存在胰管中部狭窄并认为是症状的起因，胰体尾切除术也很少能提供持久的疼痛缓解。在这部分慢性胰腺炎患者中，胰腺体尾部未被怀疑的癌经常发生。
