A Clinical Study on the Surgical Treatment for the Chronic Pancreatitis with Special Reference to Selection of Surgical Procedures from the View Point of Causative Factors and Pancreatic Lesions

Mamoru Suzuki

Department of Gastroenterological Surgery, Tokyo Women's Medical College

One hundred seventy-six consecutive patients who had pancreatic resection or pancreatic ductal drainage for chronic pancreatitis were selected for this study. Causative factors and structural abnormalities of the pancreas diagnosed by endoscopic retrograde cholangiopancreaticography [ERCP], and ultrasonography [US] or computed tomography [CT] were evaluated to select operative procedures for the patients with chronic pancreatitis. Of 114 patients with chronic alcoholic pancreatitis, 77% had diffuse type pancreatic ductal abnormalities, and 46% had inflammatory mass formation, and 56 (49%) has pancreatoduodenectomies. In 38 patients with chronic alcoholic pancreatitis who had a normal-sized or mildly dilated pancreatic duct (less than 6 mm in diameter), an inflammatory mass was present in 39%, and 21 (55%) had pancreatoduodenectomies. Of 46 patients with non-alcoholic pancreatitis, 88% had localized type pancreatic ductal abnormalities. Twenty pancreatoduodenectomies and 17 distal pancreatectomies were performed on the basis of the location of the disease. Of 16 patients with idiopathic pancreatitis, 11 had pancreatoduodenectomies for the disease in the head of the pancreas. Of the 176 patients of this series, more than 80% obtained favorable results in relieving the pain postoperatively. Selection of the operative procedure in the treatment of chronic pancreatitis can be improved further by use of US and CT findings as well as ERCP findings.

Key words
operative procedures in chronic pancreatitis, structural abnormalities of the pancreas, non-dilated pancreatic duct, inflammatory pancreatic mass formation, pancreatoduodenectomy

Reprint requests
Mamoru Suzuki Department of Gastroenterological Surgery, Tokyo Women's Medical College
8-1 Kawadacho, Shinjuku, Tokyo, 162 JAPAN

Accepted
November 19, 1990

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