Clinical Analysis of Pancreatolithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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胰腺结石; 诊断; 治疗

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目的探讨胰管结石的诊断、治疗及发病原因。
方法回顾分析1998年1月1日至2004年11月31日期间收治的有完整病史资料的88例胰管结石患者的临床特点、诊断和治疗方法。
结果88例患者病史不典型，以上腹部疼痛最常见，所有病例均伴有慢性胰腺炎。B超检查81例，诊断为胰管结石76例，胰腺钙化5例； CT检查51例，诊断为胰管结石47例，钙化4例，其中有5例疑伴胰腺癌； MRCP检查47例，诊断为胰管结石45例，胰腺钙化1例，胰腺钙化伴胰管扩张1例，其中6例疑伴胰腺癌。56例行手术治疗，53例痊愈出院，2例好转出院，1例胰管结石伴酒精性肝硬变，门静脉高压症患者术后第23 d死于肝、肾功能衰竭。25例行中西医结合治疗，17例痊愈，8例好转出院。另7例主动放弃治疗。
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或疑伴胰腺癌时，手术是其最佳选择。

Citation： 李建水,张肇达,唐勇,何满西,蒋力生,胡伟明,雷俊阳,严德辉. Clinical Analysis of Pancreatolithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(4): 456-458. doi: Copy

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10.	Takahara Y， IchijyoK， TooyamaN, et al. Breathhold MRCP with a longechotrainfast spinecho sequence and a surface coil in chroniic pancreatitis [Ｊ]. Radiology, 1994; 192(1)∶ 73.
11.	Barish MA, Sato JA. MRCP: techniques and clinical applications [Ｊ]. AJR Am J Roentgenol, 1997; 169(10)∶ 1295.
12.	Hirai T, Goto H, Hirooka Y, et al. Pilot study of pancreatoscopic lithotripsy using a 5fr instrument: selected patients may benefit [Ｊ]. Endoscopy， 2004; 36(3)∶ 212.
13.	Sells H, Moretti KL, Leong WS, et al. Use of extracorporeal shockwave lithotripsy to treat a pancreatic duct calculus [Ｊ]. ANZ J Surg, 2004; 74(1-2)∶ 84.

1. 吕云福主编. 现代胰腺外科学 [M]. 第1版. 北京：人民军医出版社, 2003∶ 245~252.
2. Ammann RW, Muench R, Otto R, et al. Evolution and regression of pancreatic calcification in chronic pancreatitis. A prospective longterm study of 107 patients [Ｊ]. Gastroenterology, 1988; 95(4)∶ 1018.
3. Takayama M, Hamano H, Ochi Y, et al. Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation [Ｊ]. Am J Gastroenterol, 2004; 99(5)∶ 932.
4. Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey [Ｊ]. Pancreas, 2005; 30(1)∶ 26.
5. 赵向前，冯玉泉，周宁新，等. 胰管结石的诊断和治疗 [Ｊ]. 中华普通外科杂志， 2002; 17(12)∶ 747.
6. Miyachi A, Kikuyama M, Matsubayashi Y, et al. Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report [Ｊ]. Gastrointest Endosc， 2004; 59(3)∶ 454.
7. Fulcher AS, Turner MA, Yelon JA, et al. Magnetic resonance cholangiopancreatography (MRCP) in the assessment of pancreatic duct trauma and its sequelae: preliminary findings [Ｊ]. J Trauma, 2000; 48(6)∶ 1001.
8. Jackson WD. Pancreatitis： etiology, diagnosis and management [Ｊ]. Curr Opin Pediatr, 2001; 13(5)∶ 447.
9. Prasad SR, Sahani D, Saini S. Clinical applications of magnetic resonance cholangiopancreatography [Ｊ]. J Clin Gastroenterol, 2001; 33(5)∶ 362.
10. Takahara Y， IchijyoK， TooyamaN, et al. Breathhold MRCP with a longechotrainfast spinecho sequence and a surface coil in chroniic pancreatitis [Ｊ]. Radiology, 1994; 192(1)∶ 73.
11. Barish MA, Sato JA. MRCP: techniques and clinical applications [Ｊ]. AJR Am J Roentgenol, 1997; 169(10)∶ 1295.
12. Hirai T, Goto H, Hirooka Y, et al. Pilot study of pancreatoscopic lithotripsy using a 5fr instrument: selected patients may benefit [Ｊ]. Endoscopy， 2004; 36(3)∶ 212.
13. Sells H, Moretti KL, Leong WS, et al. Use of extracorporeal shockwave lithotripsy to treat a pancreatic duct calculus [Ｊ]. ANZ J Surg, 2004; 74(1-2)∶ 84.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Analysis of Pancreatolithiasis

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