背景:慢性胰腺炎偶尔需要可以使用各种技术进行的手术治疗。通常,这种手术会出现术后并发症。我们报告了一例成功的逆行胰肠吻合术治疗慢性胰腺炎和感染的胰腺囊肿。
方法:一名62岁男性,有10年慢性胰腺炎病史,表现为上腹痛一周,体重下降20公斤超过一年。计算机断层扫描显示胰腺(主要是头部)结石,主胰管扩张,胰腺实质变薄.磁共振成像显示,感染的胰腺囊肿与胃相连,从脾门到肝外侧段的尾部有瘘。进行了内窥镜逆行胰管造影术;导丝无法穿过胰腺中的结石,因此,未实现主胰管引流.接下来,进行了远端胰腺和脾切除术;然而,剩余薄壁组织中的胰液被结石堵塞。因此,我们进行了逆行胰肠吻合术和Roux-en-Y吻合术.患者无术后并发症,术后第14天出院。
结论:胰体远端手术,逆行胰肠吻合术,Roux-en-Y吻合术可能是治疗难治性慢性胰腺炎的有效手术方法。
BACKGROUND: Chronic pancreatitis occasionally requires surgical treatment that can be performed with various techniques. Often, this type of surgery presents with postoperative complications. We report a case of a successful retrograde pancreatojejunostomy for chronic pancreatitis and infected pancreatic cysts.
METHODS: A 62-year-old male with a 10-year history of chronic pancreatitis presented with epigastric pain for one week and a 20 kg weight loss over one year. Computed tomography showed stones in the pancreas (mainly the head), expansion of the main pancreatic duct, and thinning of the pancreatic parenchyma. Magnetic resonance imaging showed infected pancreatic cysts connected to the stomach with a fistula from the splenic hilum to the caudal portion of the liver\'s lateral segment. An endoscopic retrograde pancreatography was performed; the guide wires could not pass through the stones in the pancreas and therefore, drainage of the main pancreatic duct was not achieved. Next, a distal pancreatomy and splenectomy were performed; however, the pancreatic juice in the remaining parenchyma was blocked by the stones. Hence, we performed a retrograde pancreatojejunostomy and Roux-en-Y anastomosis. The patient had no postoperative complications and was discharged from the hospital on postoperative day 14.
CONCLUSIONS: A distal pancreatomy, retrograde pancreatojejunostomy, and Roux-en-Y anastomosis could be an effective surgical procedure for intractable chronic pancreatitis.