Forssmann K, Schirr K, Schmid M, Schwall G, Silbernik D, Singer M V, Trede M
IV. Medizinische Universitätsklinik, Klinikum Mannheim, Universität Heidelberg.
Z Gastroenterol. 1997 Dec;35(12):1071-80.
Physicians and surgeons essentially agree today that chronic pancreatitis must primarily be treated conservatively. The aim of surgery in chronic pancreatitis is the treatment of symptoms. Surgical treatment cannot be a causal therapy for chronic pancreatitis. If surgery is indicated at all. Whipple's operation is considered to be the gold standard.
Between 1973 and 1992, out of a total of 700 patients referred to the surgery University Department in Mannheim with the express purpose of having an operation for chronic pancreatitis, duodenopancreatectomy (Whipple's operation) was performed in 110 cases. 58 of these patients were followed up postoperatively and the results have been compared with preoperative findings.
All patients returned to full or only slightly impaired activity. 60% took up work again, 40% retired after the operation with a mean age of 49 years. 38 patients (66%) were totally free of pain, 13 patients (22%) had less pain than preoperatively and only seven (12%) often need analgesics postoperatively because of abdominal pain. Preoperatively there has been a history of long-standing excessive alcohol use in 32 (55%) patients, in the postoperative period there was a significant reduction to only three (5%) patients. 40 patients clinically examined were in a sufficient nutritional condition. Exocrine function of the pancreas (stool chymotrypsin and fluorescein dilaurate test) showed an insufficiency in 20 (71%) of 28 cases. The preoperative exocrine function of the pancreas was not examined in most cases. Examination of endocrine function showed diabetes mellitus treated with insulin occurring preoperatively in six (10%) patients and in 21 (36%) patients postoperatively.
As chronic pancreatitis very often is concentrated in the head of the pancreas, Whipple's operation seems to be a good procedure for pain relief and concerning late results of life quality and socioeconomic situation.
如今内科医生和外科医生基本都认同，慢性胰腺炎必须首先进行保守治疗。慢性胰腺炎手术的目的是缓解症状。手术治疗并非慢性胰腺炎的病因治疗。如果确实需要手术，惠普尔手术被认为是金标准。
1973年至1992年间，在总共700名明确因慢性胰腺炎前来曼海姆大学外科就诊并打算接受手术的患者中，110例行十二指肠胰切除术（惠普尔手术）。其中58例患者术后接受随访，并将结果与术前情况进行比较。
所有患者恢复了全部活动或仅有轻微活动受限。60%的患者重新开始工作，40%的患者术后退休，平均年龄为49岁。38例患者（66%）完全无痛，13例患者（22%）疼痛较术前减轻，只有7例患者（12%）术后常因腹痛需要使用镇痛药。术前有32例患者（55%）有长期过量饮酒史，术后显著减少至仅3例患者（5%）。40例接受临床检查的患者营养状况良好。胰腺外分泌功能（粪便糜蛋白酶和荧光素二月桂酸酯试验）在28例中的20例（71%）显示不足。大多数病例术前未检查胰腺外分泌功能。内分泌功能检查显示，术前6例患者（10%）和术后21例患者（36%）患有胰岛素治疗的糖尿病。
由于慢性胰腺炎常集中于胰头，惠普尔手术似乎是缓解疼痛以及改善生活质量和社会经济状况远期结果的良好术式。
