Abstract
Aim. To investigate the pathogenesis of cystic inflammatory transformation of duodenal wall in patients with chronic pancreatitis (CP), described as a “duodenal dystrophy” (DD), and to improve clinical efficiency of surgical treatment. Material and Methods. 532 patients with CP were examined for the period 2004–2016. Eighty two (15.4%) patients with DD were retrospectively included over 12 years. The diagnosis of DD was established by transabdominal ultrasound, CT, MRI and endosonography. Initially, all patients were treated conservatively. 74 patients required surgical treatment subsequently after conservative treatment with a median duration of 2 years. 34 patients underwent pancreaticoduodenectomy (PD), 21 patients underwent duodenal resection, 15 – duodenum-preserving pancreatic head resection of (DPPHR). 4 patients underwent palliative operations. CP and DD were verified by histological study of surgical specimens. Not operated patients (8) are under observation. Long-term results of surgical treatment were evaluated in 47 patients with a median follow-up 49.9 months. Results. Histological examination resulted that in 69.9% DD was related with groove pancreatitis, with ectopic pancreatic tissue – in 30.1%. DD was associated with CP in 92.6% of cases. Clinical presentation of DD was not related with etiology and showed typical symptoms of CP: abdominal pain occurred in 98.8% of patients, body weight loss – 61.7%, duodenal obstruction – 35.8%, biliary hypertension – 34.6%. The overall morbidity was 35.6%. Overall postoperative mortality was 1.37% (1 patient). 66% of patients had no clinical symptoms postoperatively, a significant improvement – 32%, no effect – 2%. Conclusion. The most cases DD is related with groove pancreatitis, less frequently – with ectopic pancreatic tissue in the duodenal wall. Typically DD occurs in patients with CP. Treatment of patients with CP and DD should be started with conservative therapy. Surgery is indicated for persistent abdominal pain and presence of CP complications. Procedures of choice are PD and DPPHR.
Highlights
Histological examination resulted that in 69.9% duodenal dystrophy” (DD) was related with groove pancreatitis, with ectopic pancreatic tissue – in 30.1%
DD was associated with chronic pancreatitis (CP) in 92.6% of cases
Clinical presentation of DD was not related with etiology and showed typical symptoms of CP: abdominal pain occurred in 98.8% of patients, body weight loss – 61.7%, duodenal obstruction – 35.8%, biliary hypertension – 34.6%
Summary
Кригер А.Г., Паклина О.В., Смирнов А.В., Берелавичус С.В., Горин Д.С., Кармазановский Г.Г., Калинин Д.В. Панкреатодуоденальная резекция выполнена больным, органосохраняющие операции – больным: различные варианты резекции двенадцатиперстной кишки – 21 пациенту, резекция головки поджелудочной железы в различных модификациях – 15. При гистологическом исследовании дуоденальная дистрофия в 69,9% наблюдений ассоциирована с бороздчатым панкреатитом, эктопия ткани поджелудочной железы выявлена в 30,1% наблюдений. Дуоденальная дистрофия сочеталась с хроническим панкреатитом в 92,6% наблюдений. В большинстве наблюдений дуоденальная дистрофия ассоциирована с бороздчатым панкреатитом, реже – с эктопией ткани поджелудочной железы в стенку двенадцатиперстной кишки. В подавляющем большинстве наблюдений дуоденальная дистрофия развивается у больных хроническим панкреатитом. Лечение больных хроническим панкреатитом и дуоденальной дистрофией следует начинать с консервативной терапии. Хирургическое лечение показано при сохраняющейся боли и осложнениях хронического панкреатита, нарушении проходимости двенадцатиперстной кишки. Ключевые слова: двенадцатиперстная кишка, поджелудочная железа, дуоденальная дистрофия, бороздчатый панкреатит, хронический панкреатит, морфология, хирургическое лечение, отдаленные результаты
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