胰管结石的诊断与治疗中国普外).docVIP

胰管结石的临床分析 李建水1 张肇达2 唐 勇 2 何满西2 蒋力生2 胡伟明2 雷俊阳1 严德辉1 【摘要】目的：探讨胰管结石的诊断和治疗及发病原因。方法：回顾分析我院1998年1月1日—2004年11月31日，收治的有完整病史资料的胰管结石患者的临床特点，诊断方法和治疗。结果：共88例患者，其病史不典型，以上腹部疼痛最常见，所有病例均伴有慢性胰腺炎。56例行手术治疗，25例行中西医治疗，7例自动放弃治疗。B超辅查：81例，CT：51例， MRCP：47例。结论：B超是胰管结石的首选检查方法，MRCP对其诊断和治疗有指导意义；胰管结石伴有严重的临床症状和考虑伴胰腺癌时，手术是其最佳选择。 【关键词：】 胰腺结石 诊断 治疗 MRCP The clinical analysis of pancreatolithiasis: LIJan-shui ,ZHANG Zhao-da, TongYong, HEMan-xi, Li-shenJiang, HUWei-ming, LEIJun-yang. ﹡Department of general surgery, West China Hospital Central , Affiliated Hospital,North Sichuan Medical College ,Nanchong637000,China 【Abstract】 Objective To discuss the diagnosis and treatment and etiology of pancreatolithiasis. Methods Retrospective analysis of clinical data of all patients with pancreatolithiasis from Jan1,1998 to Nov11,2004，studied the clinical characteristics and the methods of diagnosis and treatment. Result There are 88 cases in our hospital, all accompanied with chronic pancreatitis. In the group of all patients with pancreatolithiasis, 56 cases received operation, 25 patients were treated by traditional Chinese medicine and western medicine ,and 7 cases gave up therapy. 81 cases were examined by B ultrasonography (BUS), 56 cases by Computer tomography (CT), 47 cases by Magnetic Resonance Cholangiopanceatography （MRCP）. Conclusions BUS is the first choice for diagnosis of pancreatolithiasis, MRCP is of high value in diagnosis and treatment; Pancreatolithiasis accompanied with severe clinical symptom or pancreatic carcinoma, operation is the best choice. 【Key words】 Pancreatolithiasis Diagnosis Treatment MRCP 临床上胰管结石通常分为胰管内结石（真性结石）和胰实质内钙（假性结石）两种类型，其发病率极低[1,2]。近年来，随着影像诊断技术的发展，人们对该病的认识进一步深入，其检出率明显提高。回顾四川大学华西医院从1998年1月~2004年11月共收治胰管结石患者88例，现分析如下： 1 临床资料： 1.1一般资料 患者共88例，男68例，女20例，年龄12～76岁，平均年龄45.4±6.72岁；其中，15岁以下女性3例，男性1例；所有患者均无家族史。影像学检查所有病例均伴有慢性胰腺炎；31例患者有饮酒史，全是男性，占男性的45.6％，每日量在500g左右、时间5年以上者有9例（10.2％）；3例（3.41％）患者曾患急性胰腺炎；有胆道疾患者19例（21.6％）；甲状旁腺功能亢进2例（2.27％