ABSTRACT
Objective To investigate the application value of superior mesenteric vascular right approach in duodenum-preserving pancreatic head resection for chronic pancreatitis with pancreatic head stones.Methods The retrospective descriptive study was conducted.The clinical data of 3 chronic pancreatitis patients with pancreatic head stones who were admitted to the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to May 2017 were analyzed.All the 3 patients underwent Beger procedure via superior mesenteric vascular fight approach,dissecting the posterior tunnel of pancreatic neck and gradually cutting off the pancreatic neck close to the right side of superior mesenteric vein.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative pathological examination situations;(4) follow-up situations.Follow-up was performed by outpatient examination up to December 2017,including abdominal pain,diarrhea,chills,fever,jaundice,blood glucose,liver function and tumor marker examination,and residual or recurrent stones by ultrasound,CT or MRI examination.Measurement data were represented as average (range).Results (1) Surgical situations:all the 3 patients underwent successful Beger procedure via superior mesenteric vascular right approach,including 1 combined with choledochal cyst resection,without perioperative death.The operation time,time of cutting off pancreatic neck and volume of intraoperative blood loss of 3 patients were 400 minutes (range,360-480 minutes),20 minutes (range,15-25 minutes) and 117 mL (range,50-200 mL)respectively.(2) Postoperative situations:time of initial out-of-bed activity,time to anal exsufflation and time for drinking intake were 4 days (range,3-5 days),3 days (range,2-3 days) and 3 days (range,2-4 days).One patient complicated with pancreatic fistula and gastroplegia was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 30 days postoperatively and removed drainage-tube at 47 days postoperatively.One patient with pancreatic fistula was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 28 days postoperatively and removed drainage-tube at 48 days postoperatively.One patient recovered steadily without complications and discharged at 13 days postoperatively after removal of drainage-tube.(3) Postoperative pathological examination showed that 3 patients were diagnosed as chronic pancreatitis complicated with stones of pancreatic head,including 1 along with choledochal cyst and mild atypical hyperplasia.(4) Follow-up situations:3 patients were followed up for 17-27 months with good general conditions and without abdominal pain,diarrhea,chills,fever or jaundice.Blood glucose was controlled well,and liver function and tumor marker were normal.There was no sign of residual and recurrent stones.Conclusion Beger procedure via superior mesenteric vascular right approach for chronic pancreatitis complicated with pancreatic head stones is safe and effective.
ABSTRACT
Objective To investigate the clinical efficacy of two types of duodenum-preserving pancreatic head resection (Beger procedure and Berne procedure) for chronic pancreatitis with mass in the head of the pancreas.Methods The clinical data of 46 patients with chronic pancreatitis and mass in the head of the pancreas who were admitted to the Affiliated Hospital of Guiyang Medical College from September 2008 to April 2012 were retrospectively analyzed.There were 24 patients received Beger procedure (Beger group),and 22 received Beme procedure (Berne group).The complications,life quality and pain after the operation were evaluated.Patients were followed up via phone call and out-patient examination till April 2013.The measurement data were analyzed using the Mann-Whitney U test,and the constituent ratios were compared using the chi-square test.Results The operation time and volume of blood loss were (377 ± 21) minutes and (746 ± 129) mL in the Beger group,and (323 ± 17) minutes and (577 ± 111)mL in the Berne group,with significant difference between the 2 groups (U=14.0,88.0,P ＜0.05).Four patients in the Beger group and 1 in the Berne group were complicated with pancreatic leakage,with no significant difference between the 2 groups (x2=0.714,P ＞ 0.05).The scores of life quality evaluation (physical condition,work capacity,cognitive ability,emotion,social competence and overall life quality) were 82 ± 14,74±24,90 ± 18,78±20,83 ± 18,73 ± 18 in the Beger group,and 79 ± 16,71 ±20,92 ±21,76 ± 18,80 ±21,70 ± 16 in the Berne group,with no significant difference between the 2 groups (U =177.5,183.5,187.5,178.0,189.5,192.0,P ＞ 0.05).The scores of symptom evaluation (fatigue,nausea and vomitting,pain,anorexia,dyspnea,sleep disorders,obstipation,diarrhea,financial worries) were 28 ± 16,24 ± 10,20±12,23 ± 14,4 ± 1,32 ± 12,6 ±2,18 ± 14,36± 18 in the Beger group,and 26 ± 18,26 ±20,22 ± 16,26 ± 16,3 ± 1,30 ± 10,5 ± 1,16 ± 12,38 ± 20 in the Berne group,with no significant difference between the 2 groups (U=194.5,215.5,182.5,180.5,213.0,199.0,195.0,184.5,181.5,P＞0.05).In the Beget group,19 patients did not have acute onset of pain,and 5 patients had acute onset of pain once a year; 6 patients were administered antalgesic occasionally.In the Berne group,20 patients did not have acute onset of pain,and 2 patients had acute onset of pain once a year; 4 patients were administered antalgesic occasionally,with no significant difference between the 2 groups (x2=0.485,0.041,P ＞ 0.05).All the patients were followed up,and the median time of follow-up was 36.3 months.No perforation of duodenum and steatorrhea was observed.No patient died perioperatively.Conclusion The clinical efficacy of the Berne procedure is similar to that of the Beger procedure,while the Berne procedure has advantages of easy manipulation and less operation time.