Surgical and micro-invasive treatment of pancreatic duct stones: an analysis of 42 patients / 中华肝胆外科杂志

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.

Total pancreatic head resection with duodenum and bile duct preserving: a report of 31 patients / 中华肝胆外科杂志

Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection (DBPPHR) in treatment of benign or low-grade malignant diseases located in the head of pancreas.Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People's Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively.Results Of the 31 patients,4 patients underwent laparoscopic DBPPHR.One patient in the open group was converted to pancreaticoduodenectomy.For the open group,the mean operation time was (165.3 ±63.6) min;the mean estimated blood loss was (258.1 ± 156.9) ml;and the mean postoperative stay was (11.7 ± 6.3) days.The postoperative complications included 1 reoperation due to postoperative bleeding,1 bile leakage and 13 patients developed grade A pancreatic fistula (48.2％).For the laparoscopic group,the mean operation time was 350.0 (280.0 ～ 450.0) min;the mean estimated blood loss was 425.0 (250.0 ～600.0) ml;and the mean postoperative stay was 14 days.Three patients developed postoperative pancreatic fistula (grade A).The pathological diagnosis were:12 patients with pancreatolithiasis,8 patients with serous cystadenoma,4 patients with branched intraductal papillary mucinous neoplasm,5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma.The follow-up period was 1 ～ 48 month,and there was no patient with diabetes or diarrhea.Conclusions DBPPHR was safe and efficacious.It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas.

Surgical treatment of patients with pancreatic ductal stones: a report of 60 cases / 中华肝胆外科杂志

Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones.Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study.There were 47 males and 13 females.The average age was (44.1 ± 12.0).Results All patients underwent surgical operation and there was no perioperative death.Perioperative complications occurred in 7 patients (11.7％), including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient.Eight patients developed elevated amylase levels.The fasting time was 3.4 ± 1.2 days and the hospital stay was 10.0 ±4.0 days.The follow-up rate was 88.3％ (53/60), at a mean follow-up of 27 months.In 51 patients who presented with abdominal pain, 43 patients (84.3％) had complete pain relief and 7 patients (13.7％) had partial pain relief.In 14 patients with preoperative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes.Two additional patients were diagnosed to have diabetes two years after the operation.Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation.The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer.Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close.Chronic pancreatitis also caused exocrine and endocrine dysfunction.Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

Experience for diagnosis and surgical treatment of 21 patients with pancreatic duct stone / 中国医师进修杂志

ObjectiveTo explore diagnosis and surgical treatment of pancreatic duct stone.MethodsClinical data of 21 patients with pancreatic duct stone was analyzed retrospectively. All patients were diagnosed definitely by B-ultrasonography,CT and MRI, the positive rates were 90.5％( 19/21 ),66.7％(14/21) and 55.6％ (5/9) respectively, 15 cases did transpancreatic duct lithotomy and pancreatico-intestinal anastomosis, 1 case excised the tail of pancreas simultaneously, 1 case did pancreaticoduodenectomy, 4 cases treated by endoscopy. ResultsAll operations succeeded, 1 case occurred with pancreatic leakage after a small amount of discharge tube, 1 case appeared acute pancreatitis after endoscopic treatment,who was discharged after conservative treatment. Following up 19 cases from 4 to 72 months, the symptom was released, no stone relapsed,6 cases with mild catarrhal dysentry. ConclusionB-ultrasonography, CT can basically make definite diagnosis for pancreatic duct stone, and B-ultrasonography has higher rate of diagnosis, transpancreatic duct lithotomy and pancreatico-intestinal anastomosis are the main surgical treatments, endoscopy is the method to treat pancreatic duct stone.

Clinical characteristics and surgical treatment of pancreatic duct stone / 中华内分泌外科杂志

Objective To explore clinical characteristics and surgical treatment of pancreatic duct stone.Methods Clinical data of 25 cases pancreatic duct stone undergoing operation from 1990 to 2008 were retrospectively analyzed. Results All of the 25 cases suffered upper abdominal pain, among whom 8 cases were concomitant with type 2 diabetes mellitus, 5 with steatorrhea, 2 with obstructive jaundice, 1 with pancreatic head cancer and 6 with acute pancreatitis recurrence history. All cases were confirmed by imaging diagnosis, such as ultrasonography, abdominal X-ray film, CT, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. 20 cases underwent pancreolithotomy with Roux-en-Y side-to-side pancreaticojejunostomy. 4 cases underwent body-tail pancreatectomy with pancreatojejunostomy and 1 case underwent pancreatoduodenectomy. No complication was found. 25 cases were followed for 2 months to 4 years after operation. Among all 25 cases with upper abdominal pain, 20 cases got rid of the symptoms and 5 cases were relieved postoperatively.Among 8 cases with diabetes mellitus, 4 cases resumed normal blood glucose postoperatively. Among 5 cases with steatorrhea, steatorrhea disappeared in 2 cases and 1 case were alleviated postoperatively. Conclusions Imaging examinations are the main diagnostic methods for pancreatic duct stone. Pancreolithotomy and Roux-en-Y side-toside pancreaticojejunostomy are effective operative techniques.

Migrating pancreatic duct stone: a case report / 한국간담췌외과학회지

Most reports describe acute gallstone pancreatitis as a result of common bile duct and pancreatic duct obstruction at the Ampulla of Vater. The pathophysiology leading to the development of pancreatitis includes the common channel theory of obstruction leading to bile reflux, ductal hypertension secondary to pancreatic duct obstruction, and sphincter incompetence with duodenal content reflux.Rarely stones which from common bile duct have been demonstrated by ERCP to lie within the pancreatic duct. We experienced the patient who complained epigastric and RUQ pain. She was 51-year-old and had both intrahepatic duct, common bile duct stones and pancreatic duct stone. Initial amylase and lipase was 112 IU/L, 1925 U/L. We performed Lt. lateral segmentectomy, Roux-en-Y choledochojejunostomy, distal pancreatectomy. So We report this case.

A Case of a Pancreaticobiliary Fistula Accompanied by Pancreatic Duct Stones / 대한소화기내시경학회지

A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.

The management of pancreatolithiasis:a report of 37 cases / 中国普通外科杂志

Objective To study the surgical treatment of pancreatolithiasis.Methods The clinical data of thirty-seven patients with pancreatolithiasis admitted to our hospital from 1994 to 2007 were reviewed.Results According to the results of imaging examination (BUS,CT,ERCP) and finding during surgery, pancreatolithiasis was classified into three types: TypeⅠ,the stones were mainly located in the head of pancreas, and Whipple procedure was the treatment of choice. TypeⅡ, the stones were mainly located in the body and tail of pancreas, and resection of the tail of pancreas alone or combined with splenectomy was the management of choice. TypeⅢ, the stones were diffusely scattered in the main duct from the head to tail of pancreas, and pancreatoduodenectomy,together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. There was no mortality in this series. Within 2 weeks after treatment, symptoms ameliorated to different degrees in all the patients. Thirty one patients were followed up for 6 to 72 months, the results were satisfactory.Conclusions The individualized strategy, based on the type of stone location, is of great importance in the management of pancreatolithiasis. The key of surgical treatment of pancreatolithiasis is as follows: removal of pancreatoliths, excision of diseased pancreas, and adequate pancreatic drainage.