Uravić M, Stimac D, Rubinić M, Kovac D, Zilli M, Petrosić N, Prica M
Department of Digestive Surgery, University of Rijeka, Croatia.
Minerva Chir. 1997 Jul-Aug;52(7-8):885-9.
The fibrosclerosing process of the pancreas in the chronic pancreatitis may constrict not only the pancreatic duct but also the bile duct, splenoportal venous system and duodenum. In our retrospective study we analysed 24 patients with duodenal obstruction associated with chronic pancreatitis. Duodenal obstruction was suspected whenever repeated vomiting occurred or large volumes of nasogastric aspirate were obtained. The diagnosis was confirmed by barium meal and endoscopic examination. Duodenal obstruction was relieved by gastrojejunostomy in eight patients, gastrojejunostomy and vagotomy in eight patients, gastroduodenostomy and vagotomy in two patients, vagotomy with Finney pyloroplasty in one patient, duodenoplasty with vagotomy in one patient and Whipple procedure in four patients. We concluded that vagotomy and gastroenterostomy are the procedures of choice. Bypass surgery is helpful to relieve the obstruction of the common bile duct and pancreatic duct. Whipple procedure should be reserved for the small duct form of chronic pancreatitis and for the cases in which there is high suspicion of malignancy.
慢性胰腺炎中胰腺的纤维硬化过程不仅可能会压迫胰管，还会压迫胆管、脾门静脉系统和十二指肠。在我们的回顾性研究中，我们分析了24例与慢性胰腺炎相关的十二指肠梗阻患者。每当出现反复呕吐或获得大量鼻胃吸出物时，就怀疑存在十二指肠梗阻。通过钡餐和内镜检查确诊。8例患者通过胃空肠吻合术缓解了十二指肠梗阻，8例患者通过胃空肠吻合术和迷走神经切断术，2例患者通过胃十二指肠吻合术和迷走神经切断术，1例患者通过芬尼幽门成形术加迷走神经切断术，1例患者通过十二指肠成形术加迷走神经切断术，4例患者通过惠普尔手术。我们得出结论，迷走神经切断术和胃肠吻合术是首选手术方式。旁路手术有助于缓解胆总管和胰管的梗阻。惠普尔手术应保留用于慢性胰腺炎的小导管型以及高度怀疑恶性肿瘤的病例。
