Stapleton G N, Williamson R C
Department of Surgery, Hammersmith Hospital, London, UK.
Br J Surg. 1996 Oct;83(10):1433-40. doi: 10.1002/bjs.1800831035.
A personal series is reported of 52 patients who underwent proximal pancreatoduodenectomy for severe chronic pancreatitis between 1979 and 1994. There were 13 women and 39 men of median age 42.2 (range 12-70) years. Disease predominantly affected the head of pancreas, with calcification present in 37 patients. Indications for operation were chronic pain (47 patients), obstructive jaundice (19) and duodenal stenosis (six); cancer was suspected in 12. In addition, 14 patients had a pseudocyst, two pancreatic endocrine failure and 20 exocrine failure. Aetiology was chronic alcohol abuse in 34, recurrent acute pancreatitis in five and unknown in 13. Pylorus-preserving proximal pancreatoduodenectomy was performed in 45 patients, while the remaining seven had partial gastrectomy. Drainage of a dilated distal pancreatic duct by side-to-side pancreaticojejunal anastomosis was included in 15 patients. Mean operating time was 6.2 (range 4.5-9.5) h and mean blood loss was 2.7 (range 0.2-13.0) litres. There were no hospital deaths, but three patients required a second operation and five had percutaneous drainage of infected collections. During a median follow-up of 54 months, six patients required completion distal pancreatectomy for renewed pain and four others had persistent pain. Four patients required intervention for stricture at the biliary-enteric anastomosis. Ten patients have died from causes not directly related to chronic pancreatitis. Proximal pancreatoduodenectomy is a relatively safe procedure, effectively palliating pain in 80 per cent of patients with chronic pancreatitis.
报告了一组个人病例，52例患者于1979年至1994年间因严重慢性胰腺炎接受了近端胰十二指肠切除术。其中女性13例，男性39例，中位年龄42.2岁（范围12 - 70岁）。疾病主要累及胰头，37例患者有钙化。手术指征为慢性疼痛（47例患者）、梗阻性黄疸（19例）和十二指肠狭窄（6例）；12例怀疑有癌症。此外，14例患者有假性囊肿，2例有胰腺内分泌功能衰竭，20例有外分泌功能衰竭。病因是慢性酒精滥用34例，复发性急性胰腺炎5例，13例病因不明。45例患者进行了保留幽门的近端胰十二指肠切除术，其余7例进行了部分胃切除术。15例患者包括通过胰管空肠侧侧吻合术引流扩张的远端胰管。平均手术时间为6.2小时（范围4.5 - 9.5小时），平均失血量为2.7升（范围0.2 - 13.0升）。无医院死亡病例，但3例患者需要二次手术，5例患者进行了感染灶的经皮引流。在中位随访54个月期间，6例患者因再次疼痛需要完成远端胰腺切除术，另外4例患者有持续性疼痛。4例患者因胆肠吻合口狭窄需要干预。10例患者死于与慢性胰腺炎无直接关系的原因。近端胰十二指肠切除术是一种相对安全的手术，可有效缓解80%慢性胰腺炎患者的疼痛。
