胰管结石的诊断与手术治疗（附25例报告）

摘要

目的：探讨胰管结石的珍断和手术治疗的方法。方法回顾性分析25例胰管结石临床病例。结果全组术前均行影像学检查确诊胰管结石。25例结石均成功取出，19例行胰管切开取石、胰管空肠Roux-en-Y吻合术，3例行胰体尾切除，3例行术中快速病理提示胰腺癌行胰十二指肠切除术。术后随诊6～72个月，13例术后腹痛症状完全缓解，7例获得不同程度缓解,3例伴随胰腺癌患者死亡。结论影像学检查是发现胰管结石的主要途径。外科手术是治疗胰管结石的有效方法，目前提倡个体化治疗，应该根据患者的具体情况选择合理术式,胰管切开取石、胰管空肠Roux-en-Y吻合术是目前治疗胰管结石的主要术式。%Objective To explore the operative treatment of pancreatic duct stones.Methods Data of 25 patients who underwent surgical operation for pancreatic duct stones were retrospectively analyzed.Results The diagnosis of all cases was confirmed by imaging examination.Pancreatic duct stones of all cases were removed successfully. 19 cases underwent pancreatic lithotomy with a side-to-side Roux-en-Y pancreaticojejunostomy, 3 cases underwent resection of the body and tail of the pancreas, 3 cases underwent classical Whipple procedure in intraoperative pathological diagnosis of pancreatic cancer. The period of follow-up ranged from 6-72 months.13 cases had abdominal pain completely alleviated, while 6 cases had varying degrees of alleviation. 4 cases with pancreatic cancer patients died.Conclusion Imaging examination is the main diagnosis method of pancreatic duct stones. Surgery is the effective treatment of pancreatic duct stones. Individualization treatment should be advocated. Pancreatic lithotomy with a side-to-side Roux-en-Y pancreaticojejunostomy is the main procedure for surgical treatment of pancreatic duct stones.