微创理念下慢性胰腺炎胰管结石的个体化治疗
安东均 张成 王羊 冯金鸽 崔丽萍
摘 要
目的：探讨在微创理念下采用ERCP或外科手术，个体化选择最适合的方案，改善慢性胰腺炎胰管结石的治疗效果。
方法：回顾性分析我院2007年2月～2014年3月采用ERCP介入或外科手术治疗慢性胰腺炎胰管结石38例患者的临床资料。
结果：32例（84.2%）患者接受ERCP介入治疗，成功27例；11例（含5例内镜治疗失败者）采用外科手术治疗。完全ERCP组疼痛治疗有效率为85.2%（23/27），手术组有效率为72.7%（8/11）。糖尿病和腹泻情况在ERCP及手术治疗前后无明显变化。未发生围手术期死亡病例。随访期间1例死于糖尿病肾衰，1例死于胰腺癌。
结论：慢性胰腺炎胰管结石确诊后在微创理念下强调以个体化治疗为原则的综合治疗。采用内镜技术的微创治疗以及尽可能保留胰腺组织和功能的微创手术方式，均可以取得较为满意的治疗效果。
关键词
慢性胰腺炎；胰管结石；个体化治疗；内镜；外科手术；微创外科
Individualized treatment for chronic pancreatitis with pancreatic duct stones under the concept of minimally invasive surgery
AN Dongjun，ZHANG Cheng，WANG Yang，et al.Department of Hepatobiliary Surgery，the Center Hospital of Xianyang City，Xianyang，Shanxi 712000，China
ABSTRACT
Objective：To explore the application of ERCP and other surgical procedures under the concept of minimally invasive surgery，individual choice of the most appropriate operation，to improve the treatment effect of chronic pancreatitis with pancreatic duct stones.
Methods:The clinical data of 38 patients with chronic pancreatitis combined pancreatic duct stones who received endotherapy and surgical managements in our hospital from Feb.2007 to Mar.2014 were retrospectively analyzed.
Results:Of the 38 patients，32 patient（84.2%）received endotherapy，and 27 cases were successful.Surgical managements performed for 11 cases（including 5 cases of endoscopic treatment failure）.Effective rate was 85.2%（23/27）in full endotherapy and 72.7%（8/11）in surgical managements.Before and after the two treatments，changes of diabetes mellitus and diarrhea were not obvious.There was no perioperative deaths.During the follow-up 1 case died of diabetes renal failure，1 case died of pancreatic cancer.
Conclusion:After diagnosis of chronic pancreatitis with pancreatic duct stones，comprehensive treatment under the concept of minimally invasive surgery is suggested.Minimally invasive treatment with endoscopic technique and small invasive operation mode as far as possible to retain the pancreatic tissues and functions，which can obtain satisfactory therapeutic effect.
KEY WORDS
chronic pancreatitis；pancreatic duct stones；individualized treatment；endoscopy；surgical procedures；minimally invasive surgery
近年来随着国人饮食结构和生活习惯的变化，慢性胰腺炎的发病率在不断增加，同时由于影像学诊断技术的快速提升，慢性胰腺炎胰管结石的检出率亦呈上升趋势［1］。我科2007年2月～2014年3月应用微创理念，个体化选择内镜介入或外科手术治疗慢性胰腺炎胰管结石38例患者，现对其处理方法和疗效报道如下。