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Drainage procedure for pancreatolithiasis: re-examination of the pancreatic duct diameter standard

Annals of Surgical Treatment and Research 2020년 98권 4호 p.190 ~ 198
 ( Chen Guoyong ) - Henan University People’s Hospital Zhengzhou University People’s Hospital Henan Provincial People’s Hospital Department of Hepatobiliary Surgery

 ( You Yu ) - Chongqing Medical University Second Affiliated Hospital Department of Hepatobiliary Surgery
 ( Yan Hongxian ) - Henan University People’s Hospital Zhengzhou University People’s Hospital Henan Provincial People’s Hospital Department of Hepatobiliary Surgery
 ( He Junchuang ) - Henan University People’s Hospital Zhengzhou University People’s Hospital Henan Provincial People’s Hospital Department of Hepatobiliary Surgery
 ( Gong Jianping ) - Henan University People’s Hospital Zhengzhou University People’s Hospital Henan Provincial People’s Hospital Department of Hepatobiliary Surgery
 ( Wei Sidong ) - Henan University People’s Hospital Zhengzhou University People’s Hospital Henan Provincial People’s Hospital Department of Hepatobiliary Surgery

Abstract


Purpose: Pancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown.

Methods: The clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008?2012 with 3+ years of follow-up were assessed.

Results: At postsurgical follow-up (median, 4.5 years; range, 3?7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the <8 mm group than in the >8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively.

Conclusion: Surgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.

키워드

Abdominal pain; Drainage; Operative surgical procedures; Pancreatitis; Prognosis
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