胰十二指肠切除术治疗慢性胰腺炎并发症的适应证

Q4 Medicine

International Medical Journal Pub Date : 2020-09-19 DOI:10.37436/2308-5274-2020-3-4

S. Arutyunov, M. Klymenko, K. Shamoun

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引用次数: 0

摘要

慢性胰腺炎是一种伴有胰腺实质纤维化和纤维囊性变性的复发性进行性疾病。胰腺实质纤维化的进展仍是未探索的问题，导致头部迅速扩大，并发症的发展需要切除手术。为探讨复杂形式慢性胰腺炎胰十二指肠切除术的手术治疗方法和适应证的选择，我们对137例接受胰十二指肠切除术和引流手术的患者进行了研究。12例患者完成胰十二指肠切除术。仪器研究方法:多探测器(64层)计算机断层扫描三维重建、磁共振成像、磁共振胰胆管造影、内镜逆行胰胆管造影。给出了两个临床实例。慢性胰腺炎患者胰十二指肠切除术的适应症表现为胰腺头区纤维性炎症过程，疑似肿瘤病理发展。胰腺实质的进行性纤维化改变，主要发生在头部，发生在一些患者中，与星状细胞活化和纤维化有关，它们导致胆道和门静脉高压症的发展，刺激肿瘤的发生。随着胰头纤维炎性过程的进展及并发症(胰腺、胆道和门静脉高压症)的发生，以及肿瘤无法排除的情况下，胰十二指肠切除术是首选手术。胰腺实质存在严重纤维化可降低胰十二指肠切除术时发生胰瘘的风险。关键词:复杂形式的慢性胰腺炎，胰十二指肠切除术，纤维炎性过程，胰瘘

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INDICATIONS FOR PANCREATODUODENAL RESECTION IN TREATMENT OF CHRONIC PANCREATITIS COMPLICATED FORMS

Chronic pancreatitis is a recurrent progressive disease accompanied by fibrosis and fibrocystic degeneration of the pancreatic parenchyma. There are remained the unexplored issues of progression of fibrosis in the pancreas parenchyma, which lead to a rapid enlargement of the head, the development of complications that require a resection surgery. To develop a differentiated approach to the choice of surgical treatments and indications for pancreatoduodenal resection in complicated forms of chronic pancreatitis, a study was performed in 137 patients underwent resection and drainage surgery. Pancreatoduodenal resection was accomplished in 12 patients. Instrumental research methods were used: multidetector (64−slice) computed tomography with 3D reconstruction, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography. Two clinical examples are given. Indications for pancreatoduodenal resection in patients with chronic pancreatitis were expressed fibro−inflammatory process in the area of the pancreas head, suspected development of oncological pathology. Progressive fibrotic changes in the pancreas parenchyma, mainly in the head, occurring in some patients, associated with stellate cell activation and fibrogenesis, they lead to the development of biliary and portal hypertension, stimulation of oncogenesis. It is concluded that with the progression of fibro−inflammatory process in the pancreas head with the development of complications (pancreatic, biliary and portal hypertension), as well as in case of impossibility to exclude the tumor, the surgery of choice is pancreatoduodenal resection. The presence of severe fibrosis in the pancreas parenchyma reduces the risk of developing pancreatic fistula when performing pancreatoduodenal resection. Key words: complicated forms of chronic pancreatitis, pancreatoduodenal resection, fibro−inflammatory process, pancreatic fistula

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来源期刊

International Medical Journal 医学-医学：内科

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： The International Medical Journal is intended to provide a multidisciplinary forum for the exchange of ideas and information among professionals concerned with medicine and related disciplines in the world. It is recognized that many other disciplines have an important contribution to make in furthering knowledge of the physical life and mental life and the Editors welcome relevant contributions from them. The Editors and Publishers wish to encourage a dialogue among the experts from different countries whose diverse cultures afford interesting and challenging alternatives to existing theories and practices. Priority will therefore be given to articles which are oriented to an international perspective. The journal will publish reviews of high quality on contemporary issues, significant clinical studies, and conceptual contributions, as well as serve in the rapid dissemination of important and relevant research findings. The International Medical Journal (IMJ) was first established in 1994.