ABSTRACT
Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.
ABSTRACT
Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.</p><p><b>METHODS</b>From January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.</p><p><b>RESULTS</b>Postoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.</p><p><b>CONCLUSIONS</b>Primary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Biliary Tract Surgical Procedures , Methods , Choledocholithiasis , General Surgery , Common Bile Duct , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To sum up the experience in the diagnosis and treatment of pancreatic duct stone developed as a result of long-term chronic pancreatitis. Methods The clinical data of 11 patients with pancreatolithiasis treated in our hospital from 1996 to 2002 were retrospectively analyzed. Results The main clinical manifestations included abdominal pain, back pain as well as exocrine and endocrine functional disturbance. The disease can be diagnosed by B-mode ultrasonography, CT and ERCP. Nine of 11 cases were treated by pancreaticojejunostomy, 1 case suffering from concurrent carcinoma of the head of the pancreas received pancreaticodudenectomy and 1 case underwent distal pancreatetomy. Ten patients who were followed up were free of pain . Conclusions B-mode ultrasonography is the best choice for the diagnosis of panceatolithiasis, and pancreaticojejunostomy should always be attempted for cases with duct dilatation .