Long-term follow-up study of surgical treatment for pancreatic stones.
Long-term follow-up study of surgical treatment for pancreatic stones.
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发表时间：
2007
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通讯作者：
Wen-Liang Fang;Y. Shyr;C. Su;Tien‐Hua Chen;Chew‐Wun Wu;W. Lui
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作者：
Wen-Liang Fang;Y. Shyr;C. Su;Tien‐Hua Chen;Chew‐Wun Wu;W. Lui
背景/目的胰腺结石发病率低，缺乏广泛的研究，这一领域的一些问题仍有待澄清。本文介绍了胰腺结石的外科治疗经验，尤其是手术风险和远期疗效。我们还评估了胰腺结石在胰腺炎和胰腺癌中的作用。方法分析1984-2002年间胰腺结石患者的资料，平均随访时间为67个月。对胰腺和胰腺结石的临床表现和特点进行了评价。对诊断影像研究进行比较。结果指标是手术风险，包括手术发病率和死亡率，以及长期症状控制程度。结果胰腺结石18例。病因为特发性占50%，酒精中毒占33.3%。腹痛是最常见的临床表现(100%)。胰腺癌4例(22.2%)。大部分(61.1%)的结石位于胰头。12例(66.7%)有3个以上的胰腺结石。除1例(94.4%)外，其余患者均有慢性胰腺炎表现。2例(11.8%)发生手术并发症，1例(5.9%)因肺炎导致手术死亡。术后临床症状几乎全部改善(93.8%)，其中56.3%无症状，25.0%明显改善，12.5%轻度改善。结论胰腺结石取石联合胰管引流术或胰腺切除术可能有明显的对症疗效。从缓解症状、癌症风险和低手术风险的角度来看，建议对所有胰腺结石患者进行手术干预。
BACKGROUND/AIMS With rare incidence and lack of extensive study for pancreatic stones, some issues in this area remain to be clarified. Surgical experience for pancreatic stones was presented, particularly focusing on the surgical risk and long-term outcome. We also evaluated the role of the pancreatic stone in pancreatitis and pancreatic cancer. METHODOLOGY Data of patients with pancreatic stones are analyzed between 1984 and 2002, with a median follow-up period of 67 months. Clinical features and characteristics of pancreas and pancreatic stone are evaluated. Diagnostic image studies are compared. Outcome measures are surgical risks including surgical morbidity and mortality, and degree of long-term symptom control. RESULTS There were 18 patients with pancreatic stones. The etiology was idiopathic in 50% of cases, and alcoholism in 33.3%. Abdominal pain was the most common (100%) clinical presentation. Pancreatic cancer was found in 4 (22.2%) patients. Most (61.1%) of the pancreatic stones were located in the pancreatic head. Only 1 patient had a single pancreatic stone, and 12 (66.7%) patients had more than 3 pancreatic stones. All the patients except one (94.4%) presented pictures of chronic pancreatitis. Surgical complication occurred in 2 (11.8%) patients, and surgical mortality in 1 (5.9%) resulting from pneumonia. Improvement of clinical symptoms after surgery was achieved in nearly all (93.8%) patients, including 56.3% free of symptoms, 25.0% much improvement and 12.5% mild improvement. CONCLUSIONS Removal of pancreatic stones combined with surgical drainage of pancreatic duct or resection of pancreas might have symptomatic benefits. Surgical intervention is recommended for all patients with pancreatic stones, in terms of symptom relief, cancer risk and low surgical risk.