摘要目的 探讨以慢性胰腺炎胰腺病理学形态分类为指导进行术式选择的治疗效果.方法 回顾性分析四川大学华西医院胰腺外科2010年1月至2014年12月手术治疗的295例慢性胰腺炎患者的临床资料、影像学资料、手术方式和随访情况.男性275例,女性20例;年龄14～ 74岁,中位年龄51岁.临床症状包括腹痛280例,黄疸3例,消化道出血1例,单纯腹泻或高血糖12例.按照解剖形态将患者分为5型:以胰腺纤维性萎缩和主胰管病变为主型(n=44),胰头包块型(n=69),以胰头多发结石为主型(n=165),胰头和胰体尾增生包块型(n=14例),全胰腺分支胰管多发结石伴有不同程度增生性改变型(n=3).针对不同分型,分别采用胰肠侧侧吻合术、保留十二指肠的胰头切除术、Frey手术、Burne联合胰尾部切除术或Frey联合胰尾切除术、全胰及次全胰切除治疗.所有患者出院后3个月至半年在门诊进行随访.2016年4-6月通过电话、书信、问卷和门诊进行横断面调查随访.结果 295例患者中,获得随访267例,失访28例,失访率9.5％.随访时间18 ～ 78个月,平均40个月.以胰腺纤维性萎缩和主胰管病变为主型患者的疼痛缓解率为97.0％;胰头包块型患者的疼痛缓解率为96.8％;胰头和胰体尾增生包块型患者的疼痛缓解率为96.6％;胰头和胰体尾增生包块型患者的疼痛缓解率为12/13;全胰腺分支胰管多发结石伴有不同程度增生性改变型患者的疼痛缓解率为3/3.术后新发血糖增高、需要口服降糖药物或胰岛素皮内注射19例,发生率为9.6％ (22/229).结论 根据慢性胰腺炎的病理学形态选择合理的手术方式可以做到最大限度地去除引发疼痛的原因和保留胰腺组织.

abstractsObjective Discuss the surgical options for the chronic pancreatitis on the basis of anatomical morphological changes.Methods A retrospective review of chronic pancreatitis patients in Department of Pancreatic Surgery,West China Hospital,Sichuan University between January 2010 and December 2014 was performed.The data of medical records,image feature,surgical types and records of follow-up were collected.Total 295 patients including 275 male and 20 female aged from 14 to 74 years with median age of 51 years.The clinical symptoms included abdominal pain in 280 cases,jaundice in 3 cases,single hemorrhage in digestive tract,diarrhea or mellitus in 12 cases.The anatomical morphological changes included pancreatic fibrosis and atrophy of the main pancreatic duct lesions in 44 cases (14.9％),inflammatory mass in the pancreatic head in 69 cases (22.4％),sporadic stones with calcification in the pancreatic head in 165 cases(55.9％),hyperplasia mass of pancreatic head and body in 14 cases (4.8％),sporadic stones with calcification in whole branch ducts accompanied with different degree of hyperplasia in whole pancreas in 3 cases (1.0％).The surgical options included longitudinal pancreaticojejunostomy,duodenum-preserving pancreatic head resection,Frey/Frey + distal pancreatectomy,total and subtotal pancreatectomy.All patients were followed-up for 3 to 6 months in the outpatient.A cross-sectional study was carried out by telephone,letters,questionnaire and outpatient from April to June 2016.Results Among 295 patients,267 cases were followed-up for an average time of 40 months(18 to 78 months),28 cases were lost to followed-up(9.5％).Pain remission rate of pancreatic fibrosis and atrophy of the main pancreatic duct lesions patients was 97.0％,of inflammatory mass in the pancreatic head patients was 96.8％,of sporadic stones with calcification in the pancreatic head patients was 96.6％,of hyperplasia mass of pancreatic head and body patients was 12/13,of sporadic stones with calcification in whole branch ducts accompanied with different degree of hyperplasia in whole pancreas patients was 3/3.There were 19 cases(9.6％) with blood glucose rising.Conclusion According to the pathological changes of chronic pancreatitis,the reasonable choice of surgical procedures can be done to maximize the removal of the cause of pain and the preservation of pancreatic tissue.