Objective: To investigate the surgical strategy for chronic pancreatitis complicated with suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. Methods: This is a retrospective cohort study. Clinical data from 11 patients with chronic pancreatitis who underwent pancreaticoduodenectomy combined with longitudinal pancreaticojejunostomy(PD-L) were retrospectively collected(PD-L group) from the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University between December 2021 and September 2023. All patients were male with an age of (49.0±11.2) years(range:32 to 70 years). Their primary preoperative diagnoses included pancreatic lesions, chronic pancreatitis, pancreatolithiasis, and dilatation of the pancreatic duct. Data from 248 patients who underwent pancreaticoduodenectomy(PD) during the same period were retrospectively collected(PD group). There were 157 males and 91 females in the PD group, with an age of (61.5±10.8) years(range:27 to 82 years). Among them, 87 cases were diagnosed as pancreatic cancer or chronic pancreatitis. The propensity score matching method was used to reduce confounding bias between the two groups. The caliper value of 0.1 was used and the 1∶4 nearest neighbor matching method was used for the matching. Comparisons between the two groups were made using the independent sample t test, Mann-Whitney U test or χ2 test,respectively. Results: After complete excision of the specimen during pancreaticoduodenectomy, the key surgical step of PD-L was longitudinal pancreaticojejunostomy in the remaining pancreas. Intraoperative blood loss in the PD-L group was lower than that in the PD group [M(IQR)](300(200)ml vs. 500(500)ml, respectively; P<0.05). Similarly, hospitalization days(21.0(7.0)days vs. 25.0(8.5)days) and postoperative hospitalization days(13.0(8.0)days vs. 17.0(5.0) days) were also lower in the PD-L group compared to the PD group (P<0.05). There were no significant differences in the operation time and postoperative complication rate between the two groups(P>0.05). In the PD-L group, the postoperative follow-up time was 5(5)months(range: 3 to 21 months). One case was lost for follow-up. Abdominal pain was relieved in 10 patients. Additionally, abdominal distension and steatosis were alleviated in 8 cases. Furthermore, 5 cases of diabetes mellitus showed improved control of HbA1c and fasting blood glucose levels after surgery. Conclusions: PD-L treatment can be used to treat chronic pancreatitis complicated by suspected malignant lesions in the pancreatic head and pancreatolithiasis in the distal pancreas. PD-L also has advantages in removing stones from the pancreatic duct and evaporation of pancreatic fluid. However, due to the single-center design and the small sample size of this study, further practice and long-term follow-up are still necessary.
目的： 探讨慢性胰腺炎合并胰头可疑恶性占位及胰体尾胰管结石的手术治疗效果。 方法： 本研究为回顾性队列研究。回顾性收集2021年12月至2023年9月西安交通大学第一附属医院肝胆外科收治的接受胰管纵行剖开吻合的胰十二指肠切除术（PD-L）治疗的11例慢性胰腺炎合并胰头可疑恶性占位及胰体尾胰管结石患者的资料（PD-L组）。患者均为男性，年龄（49.0±11.2）岁（范围：32~70岁）。术前主要诊断均包括胰腺占位性病变、慢性胰腺炎、胰管结石、胰管扩张。回顾性收集该科同期收治的接受胰十二指肠切除术（PD）的248例患者资料（PD组）；男性157例，女性91例；年龄（61.5±10.8）岁（范围：27~82岁）；病理学类型为胰腺癌或慢性胰腺炎87例。采用倾向性评分匹配法均衡两组的混杂偏倚，卡钳值为0.1，采用1∶4最近邻匹配法进行匹配。两组间数据的比较采用独立样本t检验、Mann-Whitney U检验或χ2检验。 结果： PD-L组术中出血量［M（IQR）］［300（200）ml］、住院时间［21.0（7.0）d］和术后住院时间［13.0（8.0）d］均低于PD组［500（500）ml、25.0（8.5）d、17.0（5.0）d］（P值均<0.05）。两组其他围手术期资料的差异无统计学意义（P值均>0.05）。PD-L组术后随访时间为5（5）个月（范围：3~21个月），失访1例，其余10例腹痛均较术前减轻，8例腹胀、脂肪泻较术前改善，5例合并糖尿病者术后糖化血红蛋白、空腹血糖较术前改善。 结论： PD-L可用于治疗慢性胰腺炎合并胰头可疑恶性占位及胰体尾多发胰管结石和狭窄，清除胰管结石较彻底，胰管引流通畅，但具体效果仍需进一步实践和长期随访。.