探讨胰管结石的分型、外科手术治疗方式的合理选择及疗效。

回顾性分析2010年1月至2012年12月在中山大学孙逸仙纪念医院收治的18例经外科手术治疗的胰管结石患者临床资料。其中男13例，女5例；平均年龄（53±12）岁。其中伴腹痛者14例，合并胰腺癌3例、胆道结石6例、糖尿病8例。所有患者均签署知情同意书，符合医学伦理学规定。观察患者围手术期情况，包括胰管结石分型、手术方式、术后并发症等，随访观察疗效。

本组所有患者均行手术治疗。2例I型胰管结石患者行胰十二指肠切除术（Whipple手术）；8例Ⅱ型及1例Ⅲ型患者行胰管切开取石+胰管空肠Roux-en-Y吻合术（Partington手术）；2例Ⅲ型患者行胰体尾及脾切除术；5例Ⅳ型患者，其中2例行Whipple手术，3例行Partington手术。无围手术期死亡。术后发生并发症5例，其中胰瘘3例，腹腔积液2例，经对症治疗后治愈。12例患者术后腹痛消失，2例腹痛明显缓解。1例合并胰腺癌患者术后1年死亡。其余患者未见结石复发。

胰管结石应遵循个体化治疗的原则，根据结石的具体分型选择合理的手术方式。胰管切开取石、胰管-空肠吻合术是主要的手术方式。

To investigate the classification, and reasonable choice and curative effect of the surgical procedures for pancreatic duct stone.

Clinical data of 18 patients with pancreatic duct stone undergoing surgery in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2010 to December 2012 were retrospectively analyzed. There were 13 males and 5 females with the average age of (53±12) years. Fourteen cases suffered from abdominal pain, 5 complicated with pancreatic cancer, 6 with bile duct stone and 8 with mellitus diabetes. The informed consents of all patients were obtained and the local ethical committee approval was received. Classification, surgical procedures and postoperative complications of the pancreatic duct stone patients during perioperative period and the curative effect during follow-up were observed.

All patients received surgical treatment. Two cases with type Ⅰ pancreatic duct stone underwent pancreaticoduodenectomy (Whipple operation), 8 with type Ⅱ and 1 with type Ⅲ underwent pancreatolithotomy + pancreato-jejunal Roux-en-Y anastomosis (Partington operation). Two with type Ⅲ underwent distal pancreatectomy + splenectomy. Among 5 cases with type Ⅳ, 2 underwent Whipple operation and 3 underwent Partington operation. No patients died during perioperative period. Postoperative complications were observed in 5 cases, including 3 with pancreatic fistula and 2 with ascites, and the patients were cured after symptomatic treatments. Abdominal pain disappeared after surgery in 12 cases and was significantly alleviated in 2 cases. One case complicated with pancreatic cancer died 1 year after surgery. No recurrence of stones was observed in the remaining cases.

Based on the priciple of individualized treatment, reasonable surgical procedure should be choosed according to the classification of pancreatic duct stone. Pancreatolithotomy and pancreatojejunostomy are the main surgical procedures.