The Superlative Results of Pylorus Preserving Pancreaticoduodenectomy for Severe Complications of Chronic Pancreatitis
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概要
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Chronic pancreatitis can result in intermittent or continuous abdominal pain. When this pain is caused by severe and sometimes life-threatening sequelae of chronic pancreatitis, a surgical intervention is usually required. Frequently the problem is located in the head of the pancreas. Examples are the expanding pseudocyst in the head with or without contained or leaking arteriovenous fistula ; a pancreatic duct blow-out with pancreatic juice penetrating into the pleural cavity, lesser sac, retroperitoneum, or leaves of omentum ; or the giant pseudotumor of calcified fibrosis with bile duct, pancreatic duct, and/or duodenal obstruction. The purpose of this paper is to analyze the clinical indications for removal of the head of the pancreas in patients with severe complications of chronic pancreatitis. Several methods can be utilized to remove the pancreatic head. These procedures include pancreaticoduodenectomy with hemigastrectomy, pancreatic-oduodenectomy with preservation of the pylorus, excision of only the pancreatic head with duodenal and common bile duct preservation, or resection of just the ventral pancreatic head. This report examines the mortality and morbidity, plus the short and long-term results of the author's preferred method to excise the pancreatic head in patients with severe complications of chronic pancreatitis, i. e. , pancreaticoduodenectomy with pylorus preservation(PDPP). The surgical treatment of chronic pancreatitis can obtain safe and superlative relief of sequelae of these severe complications only with the support of the rapidly progressing technologies of therapeutic endoscopy, interventional radiology, and anesthesiology. Therefore, only the last six years of experience with PDPP for chronic pancreatitis will be reviewed in the personal series of the author. Utilizing modern diagnostic and therapeutic techniques combined with proper patient selection, the procedure of PDPP results in solution of these severe problems and the termination of the associated abdominal pain. With PDPP every patient in this series obtained pain relief with essentially no gastrointestinal sequelae. The mortality rate of PDPP in this series was zero.
- 一般社団法人日本消化器外科学会の論文
- 1992-09-01