【摘要】：背景胰管結(jié)石(pancreatic duct stone, PDS)為一種發(fā)病率較低的疾病,自1667年DeGraaf首先描述此病后,大量學(xué)者對其病因、發(fā)病機制、臨床表現(xiàn)、診斷方案、治療方案、預(yù)后及其轉(zhuǎn)歸進行了進一步深入的研究。隨著近年來影像診斷學(xué)的飛速發(fā)展,特別是MRCP、ERCP、CT的出現(xiàn),此病檢出率逐年上升。雖然本病的發(fā)病率很低,但可加重慢性胰腺炎,增加對胰腺組織的不可逆損害,甚至可誘發(fā)胰腺癌的發(fā)生,因此對胰管結(jié)石的診斷與治療逐漸受到大家的重視。目的總結(jié)胰管結(jié)石的臨床特點及治療經(jīng)驗,提高胰管結(jié)石的臨床診斷與治療水平。方法對新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院2001年至2013年間收治的32例經(jīng)手術(shù)治療或內(nèi)鏡治療的胰管結(jié)石患者的臨床資料進行回顧分析,獲取患者年齡、性別、病程、主要臨床癥狀、手術(shù)及內(nèi)鏡治療方式、住院時間、預(yù)后及隨訪等基本信息,根據(jù)治療方式不同分為手術(shù)組和內(nèi)鏡組。對所得數(shù)據(jù)采用SPSS 19.0統(tǒng)計學(xué)軟件進行統(tǒng)計分析,比較手術(shù)組和內(nèi)鏡組臨床療效,組間對比采用t檢驗,率的比較采用χ2檢驗。結(jié)果32例患者中男性25例,女性7例,男女比例3.6：1,平均年齡39.47(23-67歲)。32例患者均伴有腹痛,且均號慢性胰腺炎合并存在,其中24例(75%)伴腰背部放射痛,2例(6.25%)伴有絞痛及劇痛；9例(28.12%)伴有腹瀉；15例(46.88%)伴有體重減輕；4例(12.5%)伴有糖尿��；1例(3.13%)伴有黃疸；3例(9.4%)伴有發(fā)熱。32例患者實驗室檢查中,4例(12.5%)伴有空腹血糖及尿糖升高；9例(28.12%)伴有血淀粉酶升高；8例(25%)伴有尿淀粉酶升高；1例(3.13%)伴血清膽紅素升高,余實驗室檢查均為陰性。術(shù)前行B超、CT、ERCP和MRCP檢查陽性率分別為86.7%、93.3%、85.7%和100%。32例均行外科手術(shù)或內(nèi)鏡治療,其中手術(shù)治療組20例,內(nèi)鏡治療組12例。手術(shù)組和內(nèi)鏡組在住院時間方面差異有統(tǒng)計學(xué)意(P0.05),內(nèi)鏡組住院時間較手術(shù)組住院時間短；在年齡、病程、隨訪時間方面兩組之間無統(tǒng)計學(xué)意義(P0.05)；在腹痛緩解方面兩組間差異有統(tǒng)計學(xué)意義(P0.05),手術(shù)組優(yōu)于內(nèi)鏡組；在腹瀉、體重減輕、糖尿病方面兩組間差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后平均隨訪39個月(2-60個月)；術(shù)后腹痛部分緩解7例,完全緩解23例；手術(shù)組20例未見結(jié)石復(fù)發(fā),內(nèi)鏡組2例分別于術(shù)后12個月、20個月發(fā)現(xiàn)結(jié)石復(fù)發(fā),均再次行內(nèi)鏡取石,至隨訪結(jié)束時未見復(fù)發(fā)。死亡2例,外科手術(shù)組1例于術(shù)后3個月死于急性心肌梗塞,內(nèi)鏡組1例于術(shù)后15個月死于胰腺癌。結(jié)論胰管結(jié)石的診斷以MRCP無創(chuàng)檢查為首選方法；根據(jù)胰管結(jié)石的臨床分型選擇個體化治療方式可取得可靠的療效；內(nèi)鏡治療也可作為胰管結(jié)石的治療方法之一。
[Abstract]:Background Pancreatic duct stone (pancreatic duct stone, PDS) is a disease with low incidence. Since DeGraaf first described the disease in 1667, a large number of scholars have further studied its etiology, pathogenesis, clinical manifestations, diagnosis, treatment, prognosis and prognosis. With the rapid development of imaging diagnostics in recent years, especially the emergence of MRCP,ERCP,CT, the detection rate of this disease is increasing year by year. Although the incidence of this disease is very low, it can aggravate chronic pancreatitis, increase the irreversible damage to pancreatic tissue, and even induce the occurrence of pancreatic cancer. Therefore, the diagnosis and treatment of pancreatic duct stones have been paid more and more attention. Objective to summarize the clinical characteristics and treatment experience of pancreatic duct stones, and to improve the clinical diagnosis and treatment of pancreatic duct stones. Methods the clinical data of 32 patients with pancreatic duct stones treated by operation or endoscopy in the first affiliated Hospital of Xinxiang Medical College from 2001 to 2013 were analyzed retrospectively. the basic information such as age, sex, course of disease, main clinical symptoms, surgical and endoscopic treatment, hospitalization time, prognosis and follow-up were obtained. The data were statistically analyzed by SPSS 19.0 statistical software. The clinical efficacy of the operation group was compared with that of the endoscopic group. T test was used to compare the data between the two groups, and the rate was compared by 蠂 2 test. Results there were 25 males and 7 females, with an average age of 39.47 (23 鈮，

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