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,2022,21(07):648-652.[doi:10.3760/cma.j.cn101785-202104058-010]
Frey手术治疗儿童慢性胰腺炎合并胰管扩张的临床分析
- Title:
- Clinical analysis of Frey’s operation for chronic pancreatitis in children complicated with pancreatic duct dilation
- Keywords:
- Pancreatectomy; Pancreatic Ducts/SU; Pancreatitis/SU; Child
- 摘要:
- 目的 总结Frey手术治疗儿童慢性胰腺炎合并胰管扩张的临床经验。方法 回顾性分析2015年1月至2020年5月复旦大学附属儿科医院16例采用Frey手术治疗的慢性胰腺炎合并胰管扩张患儿临床资料、手术治疗经过、围手术期并发症、手术效果及胰腺形态和功能。结果 16例患儿中男5例，女11例；中位手术年龄7岁10个月。14例以腹痛为首发症状，1例因消瘦于体检发现，1例为低血糖发作；血清淀粉酶143.5~678.8 U/L；胰管扩张，直径2.6~12.2 mm；胰腺彩超、磁共振胰胆管造影（magnetic resonance cholangio-pancreatography，MRCP）、增强CT提示胰管扩张、扭曲，胰腺萎缩伴周围纤维组织增生。16例均接受Frey手术，平均耗时186.1 min。10例术后第7天血清淀粉酶恢复正常，其中1例出现胰瘘，2周后自愈；1例出现梗阻性黄疸，经十二指肠乳头切开后黄疸消失；1例出现胰尾部假性囊肿，行二次手术内引流后治愈。术后随访11个月至5年，平均42个月。10例腹痛症状消失，5例术后腹痛逐渐缓解，1个月后腹痛消失；血清淀粉酶逐渐恢复正常；生长发育较满意；1例术前胰腺严重萎缩，术前低血糖发作，术后腹痛仍有反复，血清淀粉酶时有升高，生长发育稍差，但血糖控制满意。所有患儿术后未出现胰腺外分泌功能恶化，无一例术后出血及肠梗阻等并发症。结论 Frey手术治疗儿童慢性胰腺炎合并胰管扩张症安全，疗效确切，能有效缓解症状。
- 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.
参考文献/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.
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备注/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