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Abstract
The authors examined and operated on 54 chronic pancreatitis (CP) patients with pancreatic ductal hypertension. The diagnosis was confirmed according to the clinical course of CP; ultrasound, endosonography, CT, MRI, levels of endogenous insulin, parathyroid hormone, tumor marker CA 19-9, and fecal elastase 1; and intraoperative biopsy material from the head, body, and tail of the pancreas with fibrosis staging (F1–4).
We divided the patients into two groups. The main group included 28 (51.9%) patients, and the comparison group included 26 (48.1%) patients. A therapist and surgeon carefully observed patients in the main group. In compliance with detailed indications (pancreatic ductal hypertension and subcompensated exocrine insufficiency) and presented clinical classification, they underwent an organ-preserving surgery: a complete longitudinal pancreaticoduodenopapillotomy with isolated pancreaticojejunoduodenoanastomosis. The essence of the surgery is a longitudinal total dissection of the main pancreatic duct from the tail of the pancreas through the body and head. The longitudinal section ends with a dissection of the major duodenal papilla and its orifice, as well as the posteromedial wall of the duodenum, 1.5–2 cm long.
Patients in the comparison group underwent the same surgery but were hospitalized on a general basis without targeted supervision by a therapist and surgeon before the surgery.
All 28 patients (100%) in the main group had good long-term results, whereas only 2 (7.7%) in the comparison group did. The quality of life of patients in the main group corresponded to healthy individuals, and the functional state of the pancreas was at the level of subcompensation. According to the study, careful monitoring of the onset of pancreatic ductal hypertension and a decrease in the functional reserve of the pancreas in patients with CP, as conducted in the main group, allows us to determine the indications for timely organ-preserving surgery, which guarantees a high level of quality of life in the long-term perspective.
References
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