胆总管横断加胆肠吻合术治疗复发性胰腺炎探讨.docVIP

胆总管横断加胆肠吻合术治疗复发性胰腺炎46例临床分析 闫 勇，闫洪涛，汪 涛，汤礼军，张 生 （610083成都，成都军区总医院全军普外中心） [摘要]目的 探讨复发性胰腺炎的发病机制和手术治疗方法。方法 对确诊为复发性胰腺炎的46例病人，经术前MRCP、ERCP请按中文名（英文全称，缩写）形式修改检查，术中胆汁淀粉酶、胆道压力测定和胆道镜等检查，明确胆胰汇合部异常。结果 患者共同通道长度1.0 cm者13例，全组胆汁淀粉酶血淀粉酶值2倍以上。术前胆道压力平均值高于术后平均值，术后全组病例症状完全缓解，24例随访52个月无腹痛发作。结论 胆胰汇合部异常致胆汁逆流入胰管引发胰腺炎是复发性胰腺炎的重要原因，根据临床症状、胆总管扩张，共同通道长度、胆汁淀粉酶值可做出诊断。胆总管横断加胆肠吻合术是治疗这类复发性胰腺炎的有效术式。 请按中文名（英文全称，缩写）形式修改 [关键词] 复发性胰腺炎；共同通道 胆汁淀粉酶测定 胆总管横断加胆肠吻合术 [中图法分类号] [文献标志码] A Approach of Commen Bile Duct Transsection Complicated with Choledochojejunostomy to Recurrent Pancreatitis Yan Yong, Yan Hongtao, Wang Tao, Tang Lijun, Zhang Sheng (General Surgery Center of PLA.Chengdu Military General Hospital, Chengdu, Sichuan Province, 610083, China) [Abstract] Objective To explore the pathogenesis and surgical method of recurrent pancreatitis. Methods Forty six confirmed cases of CP admitted to our hospital between January 1997 and January 2009 were analyzed. Anomalous pancreaticobiliary junction was confirmed by preoperative Magnetic Resonance Cholangiopancreatography (MRCP) or/and endoscopic retrograde cholangiopancreatography(ERCP) and by intraoperative bile amylase assay, biliary tract manometry and choledochoscope etc.Results Thirteen Of all the 46 cases’ Common channel length is more than 1.0 cm; The concentration of bile amylase is more than twice as high as that of serum amylase; The preoperative mean value of bile pressure is higher than the postoperative mean value of bile pressure; All cases relieve thoroughly of the symptoms after biliopancreatic diversion;After 52 months’ follow up, 24 cases complained no recurrent abdominal pain.Conclusion Bile reflux to pancreatic duct caused by anomalous pancreaticobiliary junction leads to recurrent pancreatitis is an important cause of recurrent pancreatitis,which can be diagnosed by choledochectasia, Common channel length and bile amylase concentration. Commen bile duct transsection complicated with choledochojejunostomy is an effecti