Efficacy of duodenum-preserving pancreatic head resection for chronic pancreatitis with mass in the head of the pancreas / 中华消化外科杂志

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.