Büchler M W, Berberat P, Reber P U, Friess H
Klinik für Viszerale und Transplantationschirurgie, Universität Bern, Inselspital, Schweiz.
Ther Umsch. 1996 May;53(5):365-76.
In patients with chronic pancreatitis, surgical treatment is required when conservative approaches are unsuccessful in treating symptoms and complications of the disease. The indications for surgery are 1) recurrent abdominal pain which does not respond to analgesics and 2) duodenal, common bile duct and/or main pancreatic duct obstruction or stenosis. In addition, obstruction of the retropancreatic vessels with subsequent portal hypertension is an indication to operate. Over the last decades the surgical standards in the treatment of chronic pancreatitis have changed. Due to disappointing long-term results, pancreatic left resection and drainage procedures of the main pancreatic duct are limited only to a small number of patients. In a number of patients with chronic pancreatitis, inflammatory enlargement of the pancreatic head causes complications which require surgical treatment. In the past, the classical Whipple resection has served as the standard operation in these patients. However, the classical Whipple resection was initially inaugurated for pancreatic head malignancies, and in addition to resection of the pancreatic head it includes resection of the complete duodenum, the extra hepatic bile system and 2/3 of the stomach. The Whipple procedure's disappointing long-term results and especially its disappointing quality of life have led to the development of newer organ-preserving procedures designed to treat complications caused by chronic pancreatitis. The pylorus-preserving Whipple resection is a modification of the classical Whipple resection which avoids the resection of the stomach. Since its initial publication by Watson in 1945 and Traverso and Longmire in 1978, pylorus preserving Whipple resection has been performed by many surgeons for the treatment of chronic pancreatitis. However, the high incidence of postoperative diabetes mellitus following this operation is a major drawback that has limited its use. The duodenum-preserving pancreatic head resection was developed to selectively remove the pancreatic head subtotally by preserving the body and tail of the pancreas as well as the pylorus, the duodenum, and the extrahepatic biliary tract. With this organ-preserving operation all the pancreatic head-related complications of chronic pancreatitis can be abolished without inducing diabetes mellitus. Excellent short- and long-term follow-up results prove the superiority of the duodenum-preserving pancreatic head resection over the classical and the pylorus-preserving Whipple resections in patients with chronic pancreatitis. Therefore, the duodenum-preserving pancreatic head resection should be adopted as a new standard operation in patients with chronic pancreatitis and pancreatic head-related complications.
在慢性胰腺炎患者中，当保守治疗方法无法成功治疗疾病的症状和并发症时，就需要进行手术治疗。手术指征为：1）对镇痛药无反应的复发性腹痛；2）十二指肠、胆总管和/或主胰管梗阻或狭窄。此外，胰后血管梗阻并继发门静脉高压也是手术指征。在过去几十年里，慢性胰腺炎的手术标准发生了变化。由于长期效果令人失望，胰体尾切除术和主胰管引流术仅适用于少数患者。在许多慢性胰腺炎患者中，胰头的炎性肿大导致需要手术治疗的并发症。过去，经典的惠普尔手术一直是这些患者的标准手术。然而，经典的惠普尔手术最初是为胰头恶性肿瘤开创的，除了切除胰头外，还包括切除整个十二指肠、肝外胆道系统和三分之二的胃。惠普尔手术令人失望的长期效果，尤其是其令人失望的生活质量，促使人们开发出更新的保留器官的手术方法，以治疗慢性胰腺炎引起的并发症。保留幽门的惠普尔手术是经典惠普尔手术的一种改良，避免了胃的切除。自1945年沃森首次发表以及1978年特拉弗索和朗迈尔发表以来，许多外科医生都进行了保留幽门的惠普尔手术来治疗慢性胰腺炎。然而，该手术后糖尿病的高发病率是一个主要缺点，限制了其应用。保留十二指肠的胰头切除术旨在通过保留胰腺体尾部以及幽门、十二指肠和肝外胆道系统，选择性地部分切除胰头。通过这种保留器官的手术，可以消除慢性胰腺炎所有与胰头相关并发症，而不会诱发糖尿病。出色的短期和长期随访结果证明，在慢性胰腺炎患者中，保留十二指肠的胰头切除术优于经典的和保留幽门的惠普尔手术。因此，对于患有慢性胰腺炎且有胰头相关并发症的患者，应采用保留十二指肠的胰头切除术作为新的标准手术。
