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DOI: 10.1055/s-2001-19156
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
Chirurgische Therapie der Folgezustände
der chronischen Pankreatitis
Surgery for Complications of Chronic Pancreatitis
Publication History
Publication Date:
19 December 2001 (online)
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Summary
At least 50 % of all patients with chronic pancreatitis require surgical treatment in the course of their disease. Indications for surgery are intractable pain, intra- and extrapancreatic complications and the suspicion of a carcinoma. The basic principles of surgery are resection and drainage. The choice of the surgical procedure depends on the morphological expression and the localization of the pathological changes. Regarding resections in the head-area, previous studies demonstrated uniformly the superiority of the duodenum-preserving pancreas head resection (DPPHR) compared to the Kausch-Whipple operation with and without maintenance of the pylorus. Drainage procedures (pain recurrence in 20-40 % in the long-term course) and left pancreatic resections (de-novo diabetes mellitus in up to 45 %) should be considered critically.
Between May 1994 and November 2000 117 patients underwent surgical therapy for complications of chronic
pancreatitis at our institution. Resections were performed in 68 % of the patients and drainage procedures in 20 %. There was no mortality. Over the years the proportion of the DPPHR increased in comparison to the Kausch-Whipple procedure and the number of the drainage operations decreased continuously. The DPPHR was significantly superior to the Kausch-Whipple procedure with regard to the glucose metabolism and the quality-of-life. In the spectrum of surgical procedures in chronic pancreatitis, the DPPHR represents a modern, organ-preserving procedure for patients with complications in the pancreas head.
Zusammenfassung
Mindestens 50 % aller Patienten mit chronischer Pankreatitis werden im Krankheitsverlauf operiert. Indikationen zur Operation sind Schmerzen, intra- und extrapankreatische Komplikationen und der Verdacht auf ein Karzinom. Resektion und Drainage sind die Grundprinzipien der chirurgischen Therapie. Die Wahl des chirurgischen Verfahrens hängt von der Morphologie und der Lokalisation der pathologischen Veränderungen ab. Bei Resektionen im Kopfbereich zeigen die bisherigen Studien einheitlich die Überlegenheit der duodenumerhaltenden Pankreaskopfresektion (DEPKR) im Vergleich zur Kausch-Whipple-Operation mit und ohne Pyloruserhalt. Sehr kritisch müssen die Indikationen zur Gangdrainage wegen Schmerzrezidiven in 20-40 % und zur Pankreaslinksresektion infolge eines de-novo Diabetes mellitus in bis zu 45 % der Fälle gestellt werden.
Wir operierten von 5/1994-11/2000 117 Patienten an den Folgen einer chronischen
Pankreatitis. Bei 68 % wurden Resektionen und bei 20 % Drainageoperationen durchgeführt. Die OP-Letalität betrug 0 %. Über die Jahre nahm der proportionale Anteil der DEPKR im Vergleich zur Kausch-Whipple-Operation zu und die Anzahl der Drainageoperationen kontinuierlich ab. Die DEPKR war der Kausch-Whipple-Operation in Bezug auf den Glukosestoffwechsel und die prospektiv gemessene Lebensqualität (EORTC-Fragebogen) signifikant überlegen. Im Spektrum der chirurgischen Verfahren bei der chronischen Pankreatitis stellt die DEPKR ein modernes, organerhaltendes Verfahren bei Komplikationen im Kopfbereich dar.
Key words
Chronic pancreatitis - Indications - Surgery - Results
Schlüsselwörter
Chronische Pankreatitis - Indikationen - Chirurgische Therapie - Ergebnisse
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Priv.-Doz. Dr. med. H. Witzigmann
Klinik für Abdominal-, Transplantations- und Gefäßchirurgie der Universität Leipzig
Liebigstraße 20 a
04103 Leipzig
Phone: 03 41/9 71 72 32
Fax: 03 41/9 71 72 09
Email: with@medizin.uni-leipzig.de