【摘要】　目的　 探討胰管結(jié)石的診斷和治療方法。　方法　 回顧性分析2000年1月－2009年1月收治的50例胰管結(jié)石患者臨床資料。其中男37例，女13例；年齡36~70歲，平均49歲。病程7 d~10年，平均6.8年。46例出現(xiàn)腹正中及左上腹間歇疼痛，伴腰背部放射痛。50例均行B型超聲和CT檢查，診斷陽(yáng)性率分別為90%（45/50）和96%（48/50）；27例行磁共振胰膽管成像檢查，診斷陽(yáng)性率為92.6%（25/27）。所有患者均行手術(shù)治療，包括胰十二指腸切除術(shù)8例；胰管切開(kāi)取石、胰空腸Roux-Y吻合術(shù)42例，同時(shí)行膽囊切除術(shù)12例，Oddi括約肌切開(kāi)、T管引流術(shù)6例，膽腸Roux-Y吻合術(shù)2例。　結(jié)果　 所有患者均取出胰管結(jié)石，結(jié)石大小為0.2~2.0 cm，結(jié)石數(shù)目為1~50枚。1例患者術(shù)后發(fā)生切口感染，經(jīng)積極抗感染及傷口換藥處理后治愈。46例治愈出院，2例好轉(zhuǎn)出院， 2例術(shù)后出現(xiàn)并發(fā)癥死亡。術(shù)后40例獲隨訪(fǎng)，隨訪(fǎng)時(shí)間1~48個(gè)月，平均24個(gè)月。隨訪(fǎng)期間2例胰管結(jié)石伴胰頭癌患者因術(shù)后胰頭癌復(fù)發(fā)死亡。余38例中有8例術(shù)后胰管結(jié)石復(fù)發(fā)，再次行手術(shù)治療后治愈；其中有2例術(shù)后仍有腹痛，但較術(shù)前有明顯好轉(zhuǎn)。　結(jié)論　 影像學(xué)檢查是診斷胰管結(jié)石的重要手段，準(zhǔn)確率高，一旦診斷應(yīng)根據(jù)合并癥和胰管擴(kuò)張程度選擇合適的手術(shù)方式，可取得良好治療效果。
【Abstract】　Objective　 To investigate the diagnosis and treatment methods for pancreatolithiasis.　Methods　 The clinical data of 50 patients with pancreatolithiasis from January 2000 to January 2009 were retrospectively analyzed. Among them, there were 37 males and 13 females aged between 36 and 70 averaging at 49.3. The course of the diseases ranged from 7 days to 10 years with an average time period of 6.8 years. Forty-six patients had intermittent pain in the median abdomen and left upper quadrant combined by ectopic pain in the back. Various image examinations including abdomen ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP) were performed in 50, 50, and 27 patients, respectively. Pancreatic duct stones were found in 45 of 50 cases (90％) with ultrasonograhy, 48 of 50 cases (96%) with CT scan, and 25 of 27 cases (92.5%) with MRCP. All patients received surgeries including 8 cases of pancreatodudenectomy, 42 cases of pancreatolithotomy plus side to side pancreatojejunostomy. At the same time, there were 12 cases of cholecystectomy, 6 cases of sphincterotomy and T-duct drainage, and 2 cases of Roux-Y anastomosis.　Results　 Pancreatic duct stones were successfully removed in all cases, and the size of the stones ranged from 0.2 to 2.0 cm in diameter. The number of stones removed from each patient ranged from 1 to 50. Symptoms of all patients ameliorated obviously. One patient had incision infection after surgery, and recovered through active antibiotic treatment. Forty-six patients were cured and discharged from the hospital; 2 patients had their conditions improved and were discharged from the hospital; and the other 2 patients died of postoperative complications. Forty patients were followed up for 1 to 48 months with an average time of 24 months. During the follow-up, 2 patients with pancreatolithiasis and carcinoma of head of pancreas died of the recurrence of the cancer. Eight patients had recurrence of pancreatic stones and were cured after a second operation. Among the 8 cured patients, 2 still had abdominal pain, but their conditions were greatly improved after surgery.　Conclusion　 Imaging techniques are important methods in diagnosing pancreatolithiasis with a high precision. Once the diagnosis of pancreatolithiasis is made, surgical procedures should be selected according to the combined diseases and the level of pancreatic duct dilation.

引用本文： 淦宇,李寧,魯穩(wěn)柱,陳建宇. 胰管結(jié)石的診斷及治療. 華西醫(yī)學(xué), 2011, 26(8): 1170-1173. doi: 復(fù)制