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Objective To study the safety and feasibility of laparoscopy combined with holmium laser in the treatment of chronic pancreatitis complicated with pancreatic ductal stones.Methods To compare the clinical data in patients who underwent laparoscopy combined with holmium laser (10 patients,group A) with those who underwent laparoscopy only (21 patients,group B) at Zhejiang Provincial People' s Hospital from January 2012 to August 2018.The operation time,intraoperative blood loss,intraoperative conversion rate,pancreatic ductal incision length,postoperative pancreatic fistula rate,length of postoperative hospital stay,residual stone rate and relief of postoperative abdominal pain rate of the two groups were documented and analyzed.Results Three of 31 patients were converted to open surgery.The remaining patients in the two groups were discharged home without any perioperative death.Group A and B were significant differences in the pancreatic ductal incision length (5.0±0.8 vs.6.5±1.0) cm,operation time (289.3±51.6 vs.349.5± 34.7) min,and postoperative hospital stay (8.0± 1.2 vs.10.2± 1.6) d between the two groups (P＜0.05).There were no significant differences in the intraoperative conversion to open rate,intraoperative blood loss,postoperative pancreatic fistula rate,residual stone rate and relief of postoperative abdominal pain rate between the two groups (P ＞ 0.05).Conclusions It was safe and feasible to treat chronic pancreatitis complicated with pancreatolithiasis by laparoscopy.Laparoscopy combined with holmium laser had the added advantages of easy access through the pancreaticojejunostomy,shorter operation time,and less intraoperative blood loss.
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Objective To explore the surgical management of chronic pancreatitis complicated with pancreatolithiasis (CPPL). Methods The clinical data of 66 patients with CPPL were retrospectively analyzed. Pancreatolithiasis was classified into 4 types according to the location of stones: stones located in the head of the pancreas (type Ⅰ, n=28), stones located in the body of the pancreas (type Ⅱ, n=30), stones located in the tail of the pancreas (type Ⅲ, n=1) and stones located from the head to tail of the main duct of pancreas (type Ⅳ, n=7). Ten patients (including 4 with type Ⅰpancreatolithiasis, 5 with type Ⅱ and 1 with type Ⅳ) received conservative treatment; 10 patients with type Ⅰ pancreatolithiasis underwent lithotomy under endoscope; pancreaticoduodenectomy and Beger procedure were carried out on 14 patients with type Ⅰ pancreatolithiasis, pancreatolithotomy+pancreaticojejunostomy on 25 patients with type Ⅱ pancreatolithiasis, resection of pancreatic tail and spleen on 1 patient with type Ⅲ pancreatolithiasis, and Puestow-Gillesby procedure, dividing of the neck of pancreas+removing stones from both ends of pancreatic duct+Roux-en-Y pancreatojejunostomy on 6 patients with type Ⅳ pancreatolithiasis. Results Sixty-two patients were followed up for 2 months to 15 years, and the number of patients with recurrence for type Ⅰ, Ⅱ, Ⅲ and Ⅳ pancreatolithiasis was 4, 2, 0 and 3, respectively. Conclusions Early surgical management according to the location of stones should be carried out after confirmed diagnosis of CPPL. Individualized management based on correct diagnosis and classification plays an important role in the prevention of pancreatolithiasis recurrence.
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Objective To evaluate the clinical value of choledochoscopy combined with electrohydraulic lithotripsy (EHL) for the treatment of pancreatolithiasis. Methods From October 2002 to July 2006, choledochoscopy combined with EHL was used in 11 patients with pancreatolithiasis during a dissection of the pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis (EHL group). The data of these patients were compared with the data of 12 patients with pancreatolithiasis, who were treated by routine dissection of the pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis from January 1995 to September 2002 (Routine group). Results The intraoperative blood loss and the postoperative rate of residual stones in the EHL group were significantly less than those in the routine group [(145.5?82.0) ml vs (406.7?384.9) ml, t=-2.201, P= 0.039; and 0% vs 41.7%, P= 0.037]. The postoperative rate of pain relief in the EHL group was higher than that in the routine group (90.9% vs 58.3%), however the difference was not significant (P=0.155). In the EHL group, 6 patients had diarrhea before the operation, 4 of them achieved relief after the surgery (4/6), which was not significantly more than that in the routine group (5/9, P=1.000). Before the operation, 7 patients in the EHL group and 9 in the routine group had diabetic mellitus; in each group, the disease was relieved in 2 patients after the operation (2/7 vs 2/9, P=0.665). Conclusions Choledochoscopy combined with EHL is effective for the treatment of pancreatolithiasis. The procedure can increase the rate of stone removal, decrease the intraoperative blood loss, and elevate the postoperative rate of pain relief.
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PURPOSE: Chronic pancreatitis is difficult to cure because relapse is common. In particular the removal of stone is very difficult in pancreatolithiasis (pancreatic stone), and is associated with pancreatic duct stenosis. We attempted to evaluate the risk and the outcome of pancreatic resection in chronic pancreatitis. METHODS: We retrospectively reviewed the clinical records of twelve patients with chronic pancreatitis who had undergone pancreatic resection at our hospital between January, 1991 and December, 2000. RESULTS: Pancreaticoduodenectomy was performed in nine cases and distal pancreatectomy in three cases. In the nine cases of pancreaticoduodenectomy, five cases were associated with pancreatolith and four cases were suspected malignancy. In one case of distal pancreatectomy, a pigtail drain was inserted due to postoperative pancreatic leakage. Additionally, one patient who underwent distal pancreatectomy was readmitted one year later due to recurred pancreatitis. The remaining ten patients were discharged without complications and followed up without pain. CONCLUSION: According to two complementary theories (visceral compartment syndorme and neural inflammatory theory), pancreatic resection is better than more conservative treatment, ensuring the elimination of pain. If performed by an expert surgeon, pancreatic resection is a safe and effective treatment for chronic pancreatitis.