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Clinlcal Diagnosis and Treatment Research of Pancreatic Duct Stone

Author: Xu
Tutor: QinChengKun
School: Shandong University
Course: Surgery
Keywords: Pancreatic duct stone treatment diagnosis
CLC: R657.5
Type: Master's thesis
Year: 2012
Downloads: 71
Quote: 0
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Abstract


BACKGROUND:Pancreatic Duct Stone (PDS) is a rare disease which is caused by all kinds of ailments that make the alternation of structure and the damage of the exo-endocrine function of pancreas. The sedimentation of calcium carbonate and protein embolus in the pancreatic duct is the mainly clinical feature of this disease. PDS was firstly described by DeGraaf in1667, after which Mongragni (1765) and Cawley (1788) found stone in pancreatic duct by autopsy respectively. Then to understand the cause, mechanism,component of the stone, clinical manifestation, the method of diagnosis, the therapy and the prognosis, numerous scholars and specialists have done a lot of profound study. The incidence of PDS is low, but it may cause serious consequence, such as irreversible damage of pancreas, worsening chronic pancreatitis (CP), regional portal hypertension and hemorrhage of the upper alimentary tract even pancreatic malignant tumor of pancreas, therefore, the diagnosis and treatment of gradually attract more and more attention. To sum up the clinical characteristics and surgical treatment experience and improve the preoperative diagnosis and treatment level of PDS, a series of20patients with PDS managed in Shandong Provincial Hospital between June2002and December2010were retrospectively reviewed and analyzed.Objective:To sum up the clinical characteristics and surgical treatment experience and improve the preoperative diagnosis and treatment level of PDS.Method:A series of20patients with PDS managed in Shandong Provincial Hospital between June2002and December2010were retrospectively reviewed and analyzed. Result:14patients in20were male and6were female. The ratio to male to female is2.3:1. The mean age of the20patients is36.05years old (25-58).Among the20patients, epigastralgia in17(85%), diabetes mellitus(DM) in8(40%), fever in7(35%), steatorrhea in3(15%), obstructive jaundice in1(5%). In all male patients,11were alcoholism (more than10years), none in female.1of the female patients with systemic lupus erythematosus(SLE) and rheumatoid arthritis (RA). The all preoperative tests were negative. Ultrasonographically, the atrophy of pancreas was obvious. Hyperecho in the dilated pancreatic duct and behind which there was acoustic shadow. Computed tomgtaphy(CT) scan founded the pancreas become smaller and masses of high density in dilated pancreatic duct. And limited low-density shadow can be founded in the peripancreatic zone. In some patients, we can find the extension of common and intrahepatic biliary duct. All patients were received operative therapy. Surgical procedures include pancreatic duct incision to move stone and pancreato-jejunal Roux-en-Y anastomosis (13)、 distal pancreatectomy+pancreaticojejunostomy (3)、 distal pancreatectomy with splenectomy (2)、 duodenum preserving pancreatic head resection(l) and pancreaticoduodenectomy(1). None of the patients received radiotherapy or chemotherapy after operation.19in20were PDS with CP, and the rest one was pancreatic cancer with PDS and CP. The location of the stone was in pancreatic head(4)、 neck(5)、 body(7)、 tail(3), and in the last one the stones were diffused in all pancreas. The mean size of the stone was0.85cm(0.4-1.4cm). Post-operation complication occurred in3patients, all of which were pancreatic fistula. The patients all recovered when gave symptomatic treatment. The follow-up lasted35.5months in average (4-68months).13out of20patients were complete remission in epigastralgia,5were incompletely recover from the disease,1was unchanged and1had died of the recurrence of the malignant pancreatic carcinoma in9months.Conclusions:PDS is a rare disease which occurs with chronic pancreatitis frequently, occasionally with pancreatic cancer. Connecting the clinical manifestations (epigastralgia、 steatorrhea、 DM etc.) and the ultrasonography,CT, ERCP and MRCP to abdomen, we can diagnose the disease relatively definitely. ERCP is the gold standard of the diagnosis to PDS. The symptom (especially in epigastralgia) can be alleviated by surgical operation in most case and the prognosis is excellent.

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Pancreas
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