慢性胰腺炎_5课件.ppt

The Evolution of the Surgical Treatment of Chronic Pancreatitis;BACK GROUND;INDICATIONS FOR SURGERY;Treatment;Operative procedures ;DECOMPRESSION PROCEDURES;External drainage of the pancreatic duct to decompress obstruction caused by stricture or calculus(Fig. 1);Roux-en-Y, side-to-end, pancreaticojejunostomy The caudal, end-to-end, pancreaticojejunostomy as a drainage procedure for chronic pancreatitis (FIG 2.);Longitudinal decompre-ssion of the body and tail of the pancreas into a Roux limb of jejunum (Fig. 3) ;Side-to-side longitudinal pancreaticojejunostomy that became known as the“Puestow”procedure ( Fig. 4).; For long-term relief of pain in chronic pancreatitis, techniques of focal decompression of the ductal system were found to fail as multiple points of obstruction due to calculi or strictures are the rule in patients with alcoholic, hereditary, tropical, and idiopathic pancreatitis.;DENERVATION PROCEDURES;The effect of denervation procedures ;RESECTIONAL PROCEDURES;Pylorus Preservation Presumed nutritional and physiologic benefits associated with retention of the pylorus. Now employed in 70% to 80% of all Whipple procedures. Physiologic gastric emptying is assumed with preservation of the pylorus Increased incidence of marginal ulceration Without the high incidence of endocrine dysfunction ;Total Pancreatectomy The operation produces no better pain relief for their patients than pancreaticoduodenectomy (about 80%–85%) The metabolic consequences of total pancreatectomy in the absence of islet cell transplantation are profound and life threatening. Lethal episodes of hypoglycemia are common in severe apancreatic diabetes due to the absence of pancreatic glucagon, and to hypoglycemia unawareness Prevention of the physiological consequences of total pancreatectomy remains an unful?lled goal ;Pancreatectomy With Islet AutoTransplan-tation Methods of harvesting and gland preservation Islets are infused int