• 四川大學華西醫(yī)院肝膽胰外科(四川成都 610041);

目的探討Frey手術(shù)治療慢性胰腺炎(CP)的療效。方法回顧性分析我院2000年6月至2009年10月期間32例行Frey手術(shù)的CP患者臨床資料，觀察圍手術(shù)期并發(fā)癥發(fā)生率和疼痛緩解率，著重了解胰腺內(nèi)、外分泌功能。結(jié)果32例患者術(shù)后無死亡病例。圍手術(shù)期并發(fā)癥發(fā)生率為9.4%(3/32)。其中2例患者出現(xiàn)傷口脂肪液化，經(jīng)對癥處理后痊愈; 1例患者術(shù)后第4天出現(xiàn)胰瘺，經(jīng)禁食、營養(yǎng)支持治療康復出院。住院時間(11±2) d。術(shù)后患者均獲隨訪，隨訪時間平均43個月，16例(50.0%)患者疼痛完全消失，14例(43.8%)患者疼痛明顯緩解，2例無效，術(shù)后疼痛緩解率為93.8%。5例糖尿病患者術(shù)后病情無加重，術(shù)后新發(fā)糖尿病患者3例。3例術(shù)前伴消化不良、脂肪瀉患者中，1例術(shù)后口服胰酶制劑后癥狀緩解，2例無變化; 新增脂肪瀉患者4例。結(jié)論在嚴格掌握手術(shù)指證的前提下，采用Frey手術(shù)治療CP是一種安全、有效的方法。

引用本文： 杜冰清,陳擁華,龔軍,鄭振江,向光明,劉續(xù)寶,麥剛. Frey手術(shù)治療慢性胰腺炎的臨床療效分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(2): 187-190. doi: 復制

1. Büchler MW, Friess H, Müller MW, et al. Randomized trial of duodenumpreserving pancreatic head resection versus pyloruspreserving Whipple in chronic pancreatitis [J]. Am J Surg, 1995, 169(1): 6570.
2. 劉續(xù)寶. 慢性胰腺炎的診斷和治療 [J]. 中國普外與基礎(chǔ)臨床雜志, 2007, 14(4): 385387.
3. Sakorafas GH, Zobolas B. Lateral pancreatojejunostomy in the surgical management of chronic pancreatitis. Current concepts and future perspectives [J]. Dig Liver Dis, 2001, 33(2): 187191.
4. Sakorafas GH, Farnell MB, Nagorney DM, et al. Pancreatoduodenectomy for chronic pancreatitis: longterm results in 105 patients [J]. Arch Surg, 2000, 135(5): 517524.
5. 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.
6. Bachmann K, Mann O, Izbicki JR, et al. Chronic pancreatitis－A surgeons’ view [J]. Med Sci Monit, 2008, 14(11): RA198RA205.
7. Hildebrand P, Dudertadt S, Czymek R, et al. Different surgical strategies for chronic pancreatitis significantly improve longterm outcome: a comparative single center study [J]. Eur J Med Res, 2010, 15(8): 351356.
8. Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(2): 121133.
9. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis [J]. Gastroenterology, 2000, 119(5): 13241332.
10. Han SL, Chen J, Zhou HZ, et al. Indications and surgical treatment of chronic pancreatitis [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 638642.
11. 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.
12. MacLaren IF. Observations and surgical management of chronic pancreatitis in the British Isles: a review of the twentieth century [J]. World J Surg, 1990, 14(1): 1927.
13. 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.
14. Müller MW, Friess H, Beger HG, et al. Gastric emptying following pyloruspreserving Whipple and duodenumpreserving pancreatic head resection in patients with chronic pancreatitis [J]. Am J Surg,1997, 173(4): 257263.
15. 田孝東, 楊尹默, 莊巖, 等. 胰管結(jié)石性慢性胰腺炎的臨床特點與外科治療 [J]. 國際外科學雜志, 2007, 34(9): 595598.
16. 劉續(xù)寶, 張肇達. 慢性胰腺炎的手術(shù)治療 [J]. 中國普外與基礎(chǔ)臨床雜志, 2003, 10(6): 530531, 534.
17. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
18. Negi S, Singh A, Chaudhary A. Pain relief after Frey’s procedure for chronic pancreatitis [J]. Br J Surg, 2010, 97(7): 10871095.
19. Amudhan A, Balachandar TG, Kannan DG, et al. Factors affecting outcome after Frey procedure for chronic pancreatitis [J]. HPB (Oxford), 2008, 10(6): 477482.
20. Gall FP, Gebhardt C, Meister R, et al. Severe chronic cephalic pancreatitis: use of partial duodenopancreatectomy with occlusion of the pancreatic duct in 289 patients [J]. World J Surg, 1989, 13(6): 809817.
21. Pessaux P, Kianmanesh R, Regimbeau JM, et al. Frey procedure in the treatment of chronic pancreatitis: shortterm results [J]. Pancreas, 2006, 33(4): 354358.
22. Ramesh H, Jacob G, Lekha V, et al. Ductal drainage with head coring in chronic pancreatitis with smallduct disease [J]. J Hepatobiliary Pancreat Surg, 2003, 10(5): 366372.
23. 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.
24. Talamini G, Falconi M, Bassi C, et al. Incidence of cancer in the course of chronic pancreatitis [J]. Am J Gastroenterol, 1999, 94(5): 12531260.
25. Prinz RA, Greenlee HB. Pancreatic duct drainage in 100 patients with chronic pancreatitis [J]. Ann Surg, 1981, 194(3): 313320.
26. 趙玉沛, 李秉璐. 慢性胰腺炎與胰腺癌的關(guān)系及診治現(xiàn)狀與展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2003, 11(6): 521522.
27. Pickartz T, Mayerle J, Kraft M, et al. Chronic pancreatitis as a risk factor for the development of pancreatic cancer－diagnostic challenges [J]. Med Klin (Munich), 2010, 105(4): 281285.
  1. 1. Büchler MW, Friess H, Müller MW, et al. Randomized trial of duodenumpreserving pancreatic head resection versus pyloruspreserving Whipple in chronic pancreatitis [J]. Am J Surg, 1995, 169(1): 6570.
  2. 2. 劉續(xù)寶. 慢性胰腺炎的診斷和治療 [J]. 中國普外與基礎(chǔ)臨床雜志, 2007, 14(4): 385387.
  3. 3. Sakorafas GH, Zobolas B. Lateral pancreatojejunostomy in the surgical management of chronic pancreatitis. Current concepts and future perspectives [J]. Dig Liver Dis, 2001, 33(2): 187191.
  4. 4. Sakorafas GH, Farnell MB, Nagorney DM, et al. Pancreatoduodenectomy for chronic pancreatitis: longterm results in 105 patients [J]. Arch Surg, 2000, 135(5): 517524.
  5. 5. 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.
  6. 6. Bachmann K, Mann O, Izbicki JR, et al. Chronic pancreatitis－A surgeons’ view [J]. Med Sci Monit, 2008, 14(11): RA198RA205.
  7. 7. Hildebrand P, Dudertadt S, Czymek R, et al. Different surgical strategies for chronic pancreatitis significantly improve longterm outcome: a comparative single center study [J]. Eur J Med Res, 2010, 15(8): 351356.
  8. 8. Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis [J]. Hepatobiliary Pancreat Dis Int, 2007, 6(2): 121133.
  9. 9. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis [J]. Gastroenterology, 2000, 119(5): 13241332.
  10. 10. Han SL, Chen J, Zhou HZ, et al. Indications and surgical treatment of chronic pancreatitis [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 638642.
  11. 11. 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.
  12. 12. MacLaren IF. Observations and surgical management of chronic pancreatitis in the British Isles: a review of the twentieth century [J]. World J Surg, 1990, 14(1): 1927.
  13. 13. 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.
  14. 14. Müller MW, Friess H, Beger HG, et al. Gastric emptying following pyloruspreserving Whipple and duodenumpreserving pancreatic head resection in patients with chronic pancreatitis [J]. Am J Surg,1997, 173(4): 257263.
  15. 15. 田孝東, 楊尹默, 莊巖, 等. 胰管結(jié)石性慢性胰腺炎的臨床特點與外科治療 [J]. 國際外科學雜志, 2007, 34(9): 595598.
  16. 16. 劉續(xù)寶, 張肇達. 慢性胰腺炎的手術(shù)治療 [J]. 中國普外與基礎(chǔ)臨床雜志, 2003, 10(6): 530531, 534.
  17. 17. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
  18. 18. Negi S, Singh A, Chaudhary A. Pain relief after Frey’s procedure for chronic pancreatitis [J]. Br J Surg, 2010, 97(7): 10871095.
  19. 19. Amudhan A, Balachandar TG, Kannan DG, et al. Factors affecting outcome after Frey procedure for chronic pancreatitis [J]. HPB (Oxford), 2008, 10(6): 477482.
  20. 20. Gall FP, Gebhardt C, Meister R, et al. Severe chronic cephalic pancreatitis: use of partial duodenopancreatectomy with occlusion of the pancreatic duct in 289 patients [J]. World J Surg, 1989, 13(6): 809817.
  21. 21. Pessaux P, Kianmanesh R, Regimbeau JM, et al. Frey procedure in the treatment of chronic pancreatitis: shortterm results [J]. Pancreas, 2006, 33(4): 354358.
  22. 22. Ramesh H, Jacob G, Lekha V, et al. Ductal drainage with head coring in chronic pancreatitis with smallduct disease [J]. J Hepatobiliary Pancreat Surg, 2003, 10(5): 366372.
  23. 23. 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.
  24. 24. Talamini G, Falconi M, Bassi C, et al. Incidence of cancer in the course of chronic pancreatitis [J]. Am J Gastroenterol, 1999, 94(5): 12531260.
  25. 25. Prinz RA, Greenlee HB. Pancreatic duct drainage in 100 patients with chronic pancreatitis [J]. Ann Surg, 1981, 194(3): 313320.
  26. 26. 趙玉沛, 李秉璐. 慢性胰腺炎與胰腺癌的關(guān)系及診治現(xiàn)狀與展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2003, 11(6): 521522.
  27. 27. Pickartz T, Mayerle J, Kraft M, et al. Chronic pancreatitis as a risk factor for the development of pancreatic cancer－diagnostic challenges [J]. Med Klin (Munich), 2010, 105(4): 281285.