Li Jun,Chen Gong,Liu Baihui,et al.Clinical analysis of Frey’s operation for chronic pancreatitis in children complicated with pancreatic duct dilation[J].Journal of Clinical Pediatric Surgery,,21():648-652.[doi:10.3760/cma.j.cn101785-202104058-010]
Clinical analysis of Frey’s operation for chronic pancreatitis in children complicated with pancreatic duct dilation
- Keywords:
- Pancreatectomy; Pancreatic Ducts/SU; Pancreatitis/SU; Child
- Abstract:
- Objective To summarize the clinical efficacy of Frey’s operation for chronic pancreatitis in children with pancreatic duct dilation.Methods From January 2015 to May 2020, 16 children with chronic pancreatitis and pancreatic duct dilatation underwent Frey’s operation.Clinical data and surgical approaches were retrospectively reviewed along with perioperative complications, surgical outcomes, long-term pancreatic morphology and function.Results There were 5 boys and 11 girls with an average age of 7.8 years.Abdominal pain was an initial symptom (n=14).One case was emaciated and one case had hypoglycemia.Serum amylase ranged from 143.5 to 678.8 U/L.The diameter of pancreatic duct dilatation was (2.6-12.2) mm; color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and enhanced computed tomography (CT) indicated pancreatic duct dilatation and distortion, pancreatic atrophy with peripheral fibrous tissue hyperplasia.The average surgical duration was 132 min.During perioperative period, one patient developed pancreatic fistula and drainage tube was implanted.It healed after 2 weeks; one child of obstructive jaundice faded after endoscopic retrograde cholangiopancreatography (ERCP) duodenal papillotomy; one case of pancreatic tail pseudocyst was cured after re-operation and internal drainage.The average follow-up period was 42(11-60) months.Serum amylase of 10 cases returned to normal at Day 7 post-operation and abdominal pain disappeared; 5 cases of postoperative abdominal pain gradually relieved and disappeared 1 month later.Serum amylase gradually normalized and both growth and development were satisfactory.One case of severe preoperative pancreatic atrophy and hypoglycemia had recurrent postoperative abdominal pain, blood amylase spiked occasionally, growth and development were slightly poor and yet blood glucose was well-controlled.There was no deterioration of pancreatic exocrine function, postoperative bleeding or intestinal obstruction.Conclusion Frey’s operation is both safe and efficacious for children with chronic pancreatitis complicated with pancreatic duct dilation.Wider popularization is recommended.
References:
[1] 徐兵, 余溪洋, 孙传成.小儿慢性胰腺炎12例[J].临床小儿外科杂志, 2016, 15(3):303-305.DOI:10.3969/j.issn.1671-6353.2016.03.027.Xu B, Yu XY, Sun CC.Clinical diagnosis and treatment of chronic pancreatitis in children[J].J Chin Ped Sur, 2016, 15(3):303-305.DOI:10.3969/j.issn.1671-6353.2016.03.027.
[2] Whitcomb DC.Genetic risk factors for pancreatic disorders[J].Gastroenterology, 2013, 144(6):1292-1302.DOI:10.1053/j.gastro.2013.01.069.
[3] 中华医学会外科学分会胰腺外科学组.慢性胰腺炎诊治指南(2014)[J].中华外科杂志, 2015, 53(4):241-246.DOI:10.3760/cma.j.issn.0529-5815.2015.04.001.Group of Pancreatic Surgery, Branch of Surgery, Chinese Medical Association Guidelines for Diagnosing & Treating Chronic Pancreatitis (2014)[J].Chin J Pediatr Surg, 2015, 53(4):241-246.DOI:10.3760/cma.j.issn.0529-5815.2015.04.001.
[4] Tamura R, Ishibashi T, Takahashi S.Chronic pancreatitis:MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation[J].Radiology, 2006, 238(3):920-928.DOI:10.1148/radiol.2382041527.
[5] Whitcomb DC, Shimosegawa T, Chari ST, et al.International consensus statements on early chronic pancreatitis.recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, Pancreasfest Working Group and European Pancreatic Club[J].Pancreatology, 2018, 18(5):516-527.DOI:10.1016/j.pan.2018.05.008.
[6] Nealon WH, Thompson JC.Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression.A longitudinal prospective analysis of the modified puestow procedure[J].Ann Surg, 1993, 217(5):458-468.DOI:10.1097/00000658-199305010-00005.
[7] Ceyhan GO, Bergmann F, Kadihasanoglu M, et al.Pancreatic neuropathy and neuropathic pain-a comprehensive pathomorphological study of 546 cases[J].Gastroenterology, 2009, 136(1):177-186.e1.DOI:10.1053/j.gastro.2008.09.029.
[8] Issa Y, van Santvoort HC, van Goor H, et al.Surgical and endoscopic treatment of pain in chronic pancreatitis:a multidisciplinary update[J].Dig Surg, 2013, 30(1):35-50.DOI:10.1159/000350153.
[9] 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.DOI:10.1016/j.bpg.2010.03.003.
[10] Muniraj T, Aslanian HR, Farrell J, et al.Chronic pancreatitis, a comprehensive review and update.Part II:Diagnosis, complications, and management[J].Dis Mon, 2015, 61(1):5-37.DOI:10.1016/j.disamonth.2014.12.003.
[11] 张傲然, 杨尹默.《慢性胰腺炎外科治疗时机国际共识》评介[J].中国实用外科杂志, 2020, 40(8):909-912.DOI:10.19538/j.cjps.issn1005-2208.2020.08.03.Zhang AR, Yang YM.A review of International Consensus Guidelines for Surgery and the Timing of Intervention in Chronic Pancreatitis[J].Chinese Journal of Practical Surgery, 2020, 40(8):909-912.DOI:10.19538/j.cjps.issn1005-2208.2020.08.03.
[12] Dumonceau JM, Delhaye M, Tringali A, et al.Endoscopic treatment of chronic pancreatitis:European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline[J].Endoscopy, 2012, 44(8):784-800.DOI:10.1055/s-0032-1309840.
[13] Cahen DL, Gouma DJ, Laramée P, et al.Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis[J].Gastroenterology, 2011, 141(5):1690-1695.DOI:10.1053/j.gastro.2011.07.049.
[14] Rollins MD, Meyers RL.Frey procedure for surgical management of chronic pancreatitis in children[J].J Pediatr Surg, 2004, 39(6):817-820.DOI:10.1016/j.jpedsurg.2004.02.021.
[15] Ray S, Sanyal S, Ghatak S, et al.Frey procedure for chronic pancreatitis in children:A single center experience[J].J Pediatr Surg, 2015, 50(11):1850-1853.DOI:10.1016/j.jpedsurg.2015.07.012.
[16] Sah DN, Bhandari RS, Singh YP, et al.Early outcome of Frey’s procedure for chronic pancreatitis:Nepalese tertiary center experience[J].BMC Surg, 2019, 19(1):139.DOI:10.1186/s12893-019-0592-7.
[17] Schlosser W, Poch B, Beger HG.Duodenum-preserving pancreatic head resection leads to relief of common bile duct stenosis[J].Am J Surg, 2002, 183(1):37-41.DOI:10.1016/s0002-9610(01)00713-9.
Memo
收稿日期:2021-04-25。
基金项目:上海申康医院发展中心临床三年行动计划资助（SHDC2020CR2009A）；上海市临床重点专科（shslczdzk05703）
通讯作者:陈功,Email:chengongzlp@hotmail.com