• 四川大學(xué)華西醫(yī)院肝膽胰腺外科(四川成都 610041);

目的總結(jié)Beger及Frey手術(shù)的手術(shù)技巧及研究應(yīng)用的新進(jìn)展。方法分析、評價近年來Beger及Frey手術(shù)在胰腺良性疾病及低度惡性腫瘤中的應(yīng)用技巧,并對其臨床療效研究進(jìn)展的文獻(xiàn)進(jìn)行綜述。結(jié)果隨著器官保存觀念被廣泛接受,Beger及Frey手術(shù)被廣泛應(yīng)用,與傳統(tǒng)標(biāo)準(zhǔn)術(shù)式比較,其具有保留消化道完整、切除胰腺組織少、手術(shù)創(chuàng)傷小、術(shù)后生存質(zhì)量高及手術(shù)安全性好的優(yōu)點,但是長期療效優(yōu)勢隨著時間延長而減弱。結(jié)論Beger及Frey手術(shù)是相對安全、療效確切的術(shù)式,可作為治療胰腺良性疾病及低度惡性腫瘤特別是慢性胰腺炎的標(biāo)準(zhǔn)術(shù)式,但尚需進(jìn)一步探索研究,降低術(shù)后并發(fā)癥發(fā)生率及提高遠(yuǎn)期療效。

引用本文: 陳擁華,杜冰清,向光明,鄭振江,劉續(xù)寶,麥剛. Beger及Frey手術(shù)在胰腺良性疾病及低度惡性腫瘤治療中的應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(3): 341-347. doi: 復(fù)制

1. Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenumsparing pancreas head resection in chronic pancreatitis [J]. Chirurg, 1980, 51(5): 303307.
2. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis [J]. Pancreas, 1987, 2(6): 701707.
3. Müller MW, Friess H, Leitzbach S, et al. Perioperative and followup results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis [J]. Am J Surg, 2008, 196(3): 364372.
4. Strobel O, Büchler MW, Werner J. Surgical therapy of chronic pancreatitis: indications, techniques and results [J]. Int J Surg, 2009, 7(4): 305312.
5. Varghese TK, Bell RH Jr. Duodenumpreserving head resection for chronic pancreatitis: an institutional experience and national survey of usage [J]. Surgery, 2007, 142(4): 588593.
6. Lee SE, Jang JY, Hwang DW, et al. Clinical efficacy of organpreserving pancreatectomy for benign or lowgrade malignant potential lesion [J]. J Korean Med Sci, 2010, 25(1): 97103.
7. Bell RH Jr. Atlas of pancreatic surgery//Bell RH Jr, Rikkers LF, Mulholland MW. Digestive trac surgery. A text and Atlas [M]. Philadelphia, PA: Lippincott Raven, 1996: 10141015.
8. Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenumpreserving pancreatic head resection for benign or lowgrade malignant tumors [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792797.
9. 劉續(xù)寶, 肖乾虎. 腹部外科手術(shù)要點及圍手術(shù)期處理 [M]. 北京: 科學(xué)出版社, 2010: 436437.
10. Kat’uchová J, Bober J, Závacky P. Chronic pancreatitis, indications for resection procedures and postoperative complications [J]. Rozhl Chir, 2008, 87(4): 200206.
11. Chirletti P, Peparini N, Caronna R, et al. RouxenY endtoend and endtoside double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy [J]. Langenbecks Arch Surg, 2010, 395(1): 8993.
12. Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752757.
13. Cataldegirmen G, Bogoevski D, Mann O, et al. Late morbidity after duodenumpreserving pancreatic head resection with bile duct reinsertion into the resection cavity [J]. Br J Surg, 2008, 95(4): 447452.
14. Beger HG, Schlosser W, Friess HM, et al. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease: a singlecenter 26year experience [J]. Ann Surg, 1999, 230(4): 512519.
15. Mihaljevic AL, Kleeff J, Friess H. Beger’s operation and the Berne modification: origin and current results [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 735744.
16. Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis [J]. Dig Surg, 2001, 18(1): 2125.
17. Aspelund G, Topazian MD, Lee JH, et al. Improved outcomes for benign disease with limited pancreatic head resection [J]. J Gastrointest Surg, 2005, 9(3): 400409.
18. Farkas G, Leindler L, Daróczi M, et al. Prospective randomised comparison of organpreserving pancreatic head resection with pyloruspreserving pancreaticoduodenectomy [J]. Langenbecks Arch Surg, 2006, 391(4): 338342.
19. Riediger H, Adam U, Fischer E, et al. Longterm outcome after resection for chronic pancreatitis in 224 patients [J]. J Gastrointest Surg, 2007, 11(8): 949959.
20. Diener MK, Bruckner T, Contin P, et al. ChroPactrial: duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial [J]. Trials, 2010, 11: 47.
21. Busquets J, Fabregat J, Borobia FG, et al. Organpreserving surgery for benign lesions and lowgrade malignancies of the pancreatic head: a matched casecontrol study [J]. Surg Today, 2010, 40(2): 125131.
22. Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenumpreserving resection of the pancreatic head (Beger procedure) [J]. World J Surg, 2003, 27(11): 12171230.
23. 鄭振江, 劉續(xù)寶, 麥剛, 等. 胰十二指腸切除術(shù)和保留十二指腸的胰頭切除術(shù)治療慢性胰腺炎的臨床療效比較 [J]. 四川大學(xué)學(xué)報(醫(yī)學(xué)版) , 2008, 39(4): 686687.
24. Egawa S, Motoi F, Sakata N, et al. Assessment of Frey procedures: Japanese experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 745751.
25. Schneider CG, Cataldegirmen G, Mann O, et al. Lateral anastomosis techniques: PartingtonRochelle and Vshaped excision [J]. Chirurg, 2009, 80(1): 2833.
26. Strobel O, Büchler MW, Werner J. Duodenumpreserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications [J]. Chirurg, 2009, 80(1): 2227.
27. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
28. Ebbehj N, Borly L, Bülow J, et al. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function [J]. Scand J Gastroenterol, 1990, 25(10): 10461051.
29. Di Sebastiano P, di Mola FF, Bockman DE, et al. Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction [J]. Gut, 2003, 52(6): 907911.
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31. Beger HG, Schlosser W, Poch B, et al. Inflammatory mass in the head of pancreas//Beger HG, Warshaw AL, Büchler MW, et al. The pancreas [M]. Oxford: Blackwell Science, 1998: 757760.
32. Schlosser W, Siech M, Grich J, et al. Common bile duct stenosis in complicated chronic pancreatitis [J]. Scand J Gastroenterol, 2001, 36(2): 214219.
33. Heider TR, Azeem S, Galanko JA, et al. The natural history of pancreatitisinduced splenic vein thrombosis [J]. Ann Surg, 2004, 239(6): 876880.
34. Rieder S, Michalski CW, Friess H. Indications for endoscopic or surgical treatment of chronic pancreatitis [J]. Dig Dis, 2010, 28(2): 344349.
35. Isaji S. Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 763769.
36. Menge BA, Schrader H, Breuer TG, et al. Metabolic consequences of a 50% partial pancreatectomy in humans [J]. Diabetologia, 2009, 52(2): 306317.
37. Diener MK, Rahbari NN, Fischer L, et al. Duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and metaanalysis [J]. Ann Surg, 2008, 247(6): 950961.
38. Mihaljevic AL, Kleeff J, Friess H, et al. Surgical approaches to chronic pancreatitis [J]. Best Pract Res Clin Gastroenterol, 2008, 22(1): 167181.
39. Bachmann K, Kutup A, Mann O, et al. Surgical treatment in chronic pancreatitis timing and type of procedure [J]. Best Pract Res Clin Gastroenterol, 2010, 24(3): 299310.
40. Müller MW, Friess H, Martin DJ, et al. Longterm followup of a randomized clinical trial comparing Beger with pyloruspreserving Whipple procedure for chronic pancreatitis [J]. Br J Surg, 2008, 95(3): 350356.
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  1. 1. Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenumsparing pancreas head resection in chronic pancreatitis [J]. Chirurg, 1980, 51(5): 303307.
  2. 2. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis [J]. Pancreas, 1987, 2(6): 701707.
  3. 3. Müller MW, Friess H, Leitzbach S, et al. Perioperative and followup results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis [J]. Am J Surg, 2008, 196(3): 364372.
  4. 4. Strobel O, Büchler MW, Werner J. Surgical therapy of chronic pancreatitis: indications, techniques and results [J]. Int J Surg, 2009, 7(4): 305312.
  5. 5. Varghese TK, Bell RH Jr. Duodenumpreserving head resection for chronic pancreatitis: an institutional experience and national survey of usage [J]. Surgery, 2007, 142(4): 588593.
  6. 6. Lee SE, Jang JY, Hwang DW, et al. Clinical efficacy of organpreserving pancreatectomy for benign or lowgrade malignant potential lesion [J]. J Korean Med Sci, 2010, 25(1): 97103.
  7. 7. Bell RH Jr. Atlas of pancreatic surgery//Bell RH Jr, Rikkers LF, Mulholland MW. Digestive trac surgery. A text and Atlas [M]. Philadelphia, PA: Lippincott Raven, 1996: 10141015.
  8. 8. Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenumpreserving pancreatic head resection for benign or lowgrade malignant tumors [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792797.
  9. 9. 劉續(xù)寶, 肖乾虎. 腹部外科手術(shù)要點及圍手術(shù)期處理 [M]. 北京: 科學(xué)出版社, 2010: 436437.
  10. 10. Kat’uchová J, Bober J, Závacky P. Chronic pancreatitis, indications for resection procedures and postoperative complications [J]. Rozhl Chir, 2008, 87(4): 200206.
  11. 11. Chirletti P, Peparini N, Caronna R, et al. RouxenY endtoend and endtoside double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy [J]. Langenbecks Arch Surg, 2010, 395(1): 8993.
  12. 12. Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752757.
  13. 13. Cataldegirmen G, Bogoevski D, Mann O, et al. Late morbidity after duodenumpreserving pancreatic head resection with bile duct reinsertion into the resection cavity [J]. Br J Surg, 2008, 95(4): 447452.
  14. 14. Beger HG, Schlosser W, Friess HM, et al. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease: a singlecenter 26year experience [J]. Ann Surg, 1999, 230(4): 512519.
  15. 15. Mihaljevic AL, Kleeff J, Friess H. Beger’s operation and the Berne modification: origin and current results [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 735744.
  16. 16. Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis [J]. Dig Surg, 2001, 18(1): 2125.
  17. 17. Aspelund G, Topazian MD, Lee JH, et al. Improved outcomes for benign disease with limited pancreatic head resection [J]. J Gastrointest Surg, 2005, 9(3): 400409.
  18. 18. Farkas G, Leindler L, Daróczi M, et al. Prospective randomised comparison of organpreserving pancreatic head resection with pyloruspreserving pancreaticoduodenectomy [J]. Langenbecks Arch Surg, 2006, 391(4): 338342.
  19. 19. Riediger H, Adam U, Fischer E, et al. Longterm outcome after resection for chronic pancreatitis in 224 patients [J]. J Gastrointest Surg, 2007, 11(8): 949959.
  20. 20. Diener MK, Bruckner T, Contin P, et al. ChroPactrial: duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial [J]. Trials, 2010, 11: 47.
  21. 21. Busquets J, Fabregat J, Borobia FG, et al. Organpreserving surgery for benign lesions and lowgrade malignancies of the pancreatic head: a matched casecontrol study [J]. Surg Today, 2010, 40(2): 125131.
  22. 22. Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenumpreserving resection of the pancreatic head (Beger procedure) [J]. World J Surg, 2003, 27(11): 12171230.
  23. 23. 鄭振江, 劉續(xù)寶, 麥剛, 等. 胰十二指腸切除術(shù)和保留十二指腸的胰頭切除術(shù)治療慢性胰腺炎的臨床療效比較 [J]. 四川大學(xué)學(xué)報(醫(yī)學(xué)版) , 2008, 39(4): 686687.
  24. 24. Egawa S, Motoi F, Sakata N, et al. Assessment of Frey procedures: Japanese experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 745751.
  25. 25. Schneider CG, Cataldegirmen G, Mann O, et al. Lateral anastomosis techniques: PartingtonRochelle and Vshaped excision [J]. Chirurg, 2009, 80(1): 2833.
  26. 26. Strobel O, Büchler MW, Werner J. Duodenumpreserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications [J]. Chirurg, 2009, 80(1): 2227.
  27. 27. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
  28. 28. Ebbehj N, Borly L, Bülow J, et al. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function [J]. Scand J Gastroenterol, 1990, 25(10): 10461051.
  29. 29. Di Sebastiano P, di Mola FF, Bockman DE, et al. Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction [J]. Gut, 2003, 52(6): 907911.
  30. 30. Zhu ZW, Friess H, Wang L, et al. Brainderived neurotrophic factor (BDNF) is upregulated and associated with pain in chronic pancreatitis [J]. Dig Dis Sci, 2001, 46(8): 16331639.
  31. 31. Beger HG, Schlosser W, Poch B, et al. Inflammatory mass in the head of pancreas//Beger HG, Warshaw AL, Büchler MW, et al. The pancreas [M]. Oxford: Blackwell Science, 1998: 757760.
  32. 32. Schlosser W, Siech M, Grich J, et al. Common bile duct stenosis in complicated chronic pancreatitis [J]. Scand J Gastroenterol, 2001, 36(2): 214219.
  33. 33. Heider TR, Azeem S, Galanko JA, et al. The natural history of pancreatitisinduced splenic vein thrombosis [J]. Ann Surg, 2004, 239(6): 876880.
  34. 34. Rieder S, Michalski CW, Friess H. Indications for endoscopic or surgical treatment of chronic pancreatitis [J]. Dig Dis, 2010, 28(2): 344349.
  35. 35. Isaji S. Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 763769.
  36. 36. Menge BA, Schrader H, Breuer TG, et al. Metabolic consequences of a 50% partial pancreatectomy in humans [J]. Diabetologia, 2009, 52(2): 306317.
  37. 37. Diener MK, Rahbari NN, Fischer L, et al. Duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and metaanalysis [J]. Ann Surg, 2008, 247(6): 950961.
  38. 38. Mihaljevic AL, Kleeff J, Friess H, et al. Surgical approaches to chronic pancreatitis [J]. Best Pract Res Clin Gastroenterol, 2008, 22(1): 167181.
  39. 39. Bachmann K, Kutup A, Mann O, et al. Surgical treatment in chronic pancreatitis timing and type of procedure [J]. Best Pract Res Clin Gastroenterol, 2010, 24(3): 299310.
  40. 40. Müller MW, Friess H, Martin DJ, et al. Longterm followup of a randomized clinical trial comparing Beger with pyloruspreserving Whipple procedure for chronic pancreatitis [J]. Br J Surg, 2008, 95(3): 350356.
  41. 41. McClaine RJ, Lowy AM, Matthews JB, et al. A comparison of pancreaticoduodenectomy and duodenumpreserving head resection for the treatment of chronic pancreatitis [J]. HPB (Oxford), 2009, 11(8): 677683.
  42. 42. Strate T, Taherpour Z, Bloechle C, et al. Longterm followup of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis [J]. Ann Surg, 2005, 241(4): 591598.
  43. 43. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis [J]. Gastroenterology, 2000, 119(5): 13241332.
  44. 44. Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenumpreserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial [J]. Ann Surg, 1995, 221(4): 350358.
  45. 45. Keck T, Wellner UF, Riediger H, et al. Longterm outcome after 92 duodenumpreserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures [J]. J Gastrointest Surg, 2010, 14(3): 549556.
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