The Korean Journal of Medicine

  • 제83권1호
  • /
  • Pages.40-49
  • /
  • 2012
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

만성췌장염의 외과적 치료

Surgical Treatment of Chronic Pancreatitis

  • 최동호 (순천향대학교 의과대학 외과학교실)
  • Choi, Dong-Ho (Department of Surgery, Soonchunhyang University College of Medicine)
  • 발행 : 2012.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

Treatment of chronic pancreatitis (CP) is a challenging disease for surgeons. During the last several decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and development of sophisticated diagnostic methods in clinical practice have resulted in significant changes in surgery for CP. Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy and pathophysiology, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. Even though available results from randomized controlled trials were published, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

키워드

참고문헌

  1. Kim CD. Current status of acute pancreatitis in Korea. Korean J Gastroenterol 2003;42:1-11.
  2. Kang MS, Lee YS, Park JH, Lee BC. Surgical treatment of acute necrotizing pancreatitis. J Korean Surg Soc 1998;54: 283-290.
  3. Cooperman AM. Surgery and chronic pancreatitis. Surg Clin North Am 2001;81:431-455. https://doi.org/10.1016/S0039-6109(05)70131-6
  4. Haggard WD, Kirtley JA. Pancreatic calculi: a review of sixty-five operative and one hundred thirty-nine non-operative cases. Ann Surg 1939;109:809-826. https://doi.org/10.1097/00000658-193905000-00013
  5. Planche NE, Palasciano G, Meullenet J, Laugier R, Sarles H. Effects of intravenous alcohol on pancreatic and biliary secretion in man. Dig Dis Sci 1982;27:449-453. https://doi.org/10.1007/BF01295655
  6. Ahn CS, Jang HJ, Kim SC, Han DJ. Surgical treatment of chronic pancreatitis. J Korean Surg Soc 1999;56:410-419.
  7. Sakakibara A, Okumura N, Hayakawa T, Kanzaki M. Ultrastructural changes in the exocrine pancreas of experimental pancreatolithiasis in dogs. Am J Gastroenterol 1982;77:498-503.
  8. Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG. Surgical management of chronic pancreatitis at the Mayo Clinic. Surg Clin North Am 2001;81:457-465. https://doi.org/10.1016/S0039-6109(05)70132-8
  9. Ihse I, Borch K, Larsson J. Chronic pancreatitis: results of operations for relief of pain. World J Surg 1990;14:53-58. https://doi.org/10.1007/BF01670546
  10. Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis: longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984;86(5 Pt 1):820-828.
  11. Doubilet H, Mulholland JH. The surgical treatment of recurrent acute pancreatitis by endocholedochal sphincterotomy. Surg Gynecol Obstet 1948;86:295-306.
  12. Doubilet H, Mulholland JH. Eight-year study of pancreatitis and sphincterotomy. J Am Med Assoc 1956;160:521-528. https://doi.org/10.1001/jama.1956.02960420001001
  13. Rosch T, Daniel S, Scholz M, et al. Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy 2002;34:765-771. https://doi.org/10.1055/s-2002-34256
  14. Morgan DE, Smith JK, Hawkins K, Wilcox CM. Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency. Am J Gastroenterol 2003;98:821-826. https://doi.org/10.1111/j.1572-0241.2003.07381.x
  15. Gabbrielli A, Pandolfi M, Mutignani M, et al. Efficacy of main pancreatic-duct endoscopic drainage in patients with chronic pancreatitis, continuous pain, and dilated duct. Gastrointest Endosc 2005;61:576-581. https://doi.org/10.1016/S0016-5107(05)00295-6
  16. Eleftherladis N, Dinu F, Delhaye M, et al. Long-term outcome after pancreatic stenting in severe chronic pancreatitis. Endoscopy 2005;37:223-230 https://doi.org/10.1055/s-2005-860988
  17. Vitale GC, Cothron K, Vitale EA, et al. Role of pancreatic duct stenting in the treatment of chronic pancreatitis. Surg Endosc 2004;18:1431-1434. https://doi.org/10.1007/s00464-003-8933-z
  18. Ponchon T, Bory RM, Hedelius F, et al. Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol. Gastrointest Endosc 1995;42:452-456. https://doi.org/10.1016/S0016-5107(95)70049-8
  19. Link G. Pancreatostomy for chronic pancreatitis with calculi in the duct of Wirsung and diffuse calcinosis of the pancreatic parenchyma. Ann Surg 1953;138:287-288.
  20. DuVal MK Jr. Caudal pancreatico-jejunostomy for chronic relapsing pancreatitis. Ann Surg 1954;140:775-785. https://doi.org/10.1097/00000658-195412000-00001
  21. Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958;76:898-907. https://doi.org/10.1001/archsurg.1958.01280240056009
  22. Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960;152:1037-1043. https://doi.org/10.1097/00000658-196012000-00015
  23. Priestley JT, Comfort MW, Radcliffe J. Total pancreatectomy for hyperinsulinism due to an islet-cell adenoma: survival and cure at sixteen months after operation presentation of metabolic studies. Ann Surg 1944;119:211-221. https://doi.org/10.1097/00000658-194402000-00004
  24. Whipple AO. Radical surgery for certain cases of pancreatic fibrosis associated with calcareous deposits. Ann Surg 1946;124:991-1006. https://doi.org/10.1097/00000658-194612000-00001
  25. Eliason EL, Welty RF. Pancreatic calculi. Ann Surg 1948;127:150-157. https://doi.org/10.1097/00000658-194801000-00015
  26. Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978;146:959-962.
  27. Moosa AR. Surgical treatment of chronic pancreatitis: an overview. Br J Surg 1987;74:661-667. https://doi.org/10.1002/bjs.1800740803
  28. Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis: long-term results in 105 patients. Arch Surg 2000;135:517-523. https://doi.org/10.1001/archsurg.135.5.517
  29. Jimenez RE, Fernandez-Del Castillo C, Rattner DW, Warshaw AL. Pylorus-preserving pancreaticoduodenectomy in the treatment of chronic pancreatitis. World J Surg 2003;27:1211-1216. https://doi.org/10.1007/s00268-003-7240-0
  30. Gall FP, Muhe E, Gebhardt C. Results of partial and total pancreaticoduodenectomy in 117 patients with chronic pancreatitis. World J Surg 1981;5:269-275. https://doi.org/10.1007/BF01658311
  31. Russell RC, Theis BA. Pancreatoduodenectomy in the treatment of chronic pancreatitis. World J Surg 2003;27:1203-1210. https://doi.org/10.1007/s00268-003-7239-6
  32. Vickers SM, Chan C, Heslin MJ, Bartolucci A, Aldrete JS. The role of pancreaticoduodenectomy in the treatment of severe chronic pancreatitis. Am Surg 1999;65:1108-1111.
  33. Traverso LW. The pylorus preserving Whipple procedure for the treatment of chronic pancreatitis. Swiss Surg 2000;6:259-263. https://doi.org/10.1024/1023-9332.6.5.259
  34. McLaughlin EF, Harris JS. Total pancreatectomy for recurrent calcareous pancreatitis. Ann Surg 1952;136:1024-1030. https://doi.org/10.1097/00000658-195212000-00017
  35. Braasch JW, Vito L, Nugent FW. Total pancreatectomy of end-stage chronic pancreatitis. Ann Surg 1978;188:317-322. https://doi.org/10.1097/00000658-197809000-00006
  36. Cooper MJ, Williamson RC, Benjamin IS, et al. Total pancreatectomy for chronic pancreatitis. Br J Surg 1987;74:912-915. https://doi.org/10.1002/bjs.1800741013
  37. Sawyer R, Frey CF. Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis? Am J Surg 1994;168:6-9. https://doi.org/10.1016/S0002-9610(05)80061-3
  38. Bradley EL 3rd. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg 1987;153:207-213. https://doi.org/10.1016/0002-9610(87)90816-6
  39. Mannell A, Adson MA, McIlrath DC, Ilstrup DM. Surgical management of chronic pancreatitis: long-term results in 141 patients. Br J Surg 1988;75:467-472. https://doi.org/10.1002/bjs.1800750522
  40. Taylor RH, Bagley FH, Braasch JW, Warren KW. Ductal drainage or resection for chronic pancreatitis. Am J Surg 1981;141:28-33. https://doi.org/10.1016/0002-9610(81)90007-6
  41. Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE. Longitudinal V-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg 1998;227:213-219. https://doi.org/10.1097/00000658-199802000-00010
  42. Beger HG, Witte C, Krautzberger W, Bittner R. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg 1980;51:303-307.
  43. Buchler MW, Friess H, Bittner R, et al. Duodenumpreserving pancreatic head resection: long-term results. J Gastrointest Surg 1997;1:13-19 https://doi.org/10.1007/s11605-006-0004-z
  44. Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg 1999;230:512-519. https://doi.org/10.1097/00000658-199910000-00007
  45. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987;2:701-707. https://doi.org/10.1097/00006676-198711000-00014
  46. Frey CF, Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 1994;220:492-504. https://doi.org/10.1097/00000658-199410000-00008
  47. Gloor B, Friess H, Uhl W, Büchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 2001;18:21-25. https://doi.org/10.1159/000050092
  48. Klempa I, Spatny M, Menzel J, et al. Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation. Chirurg 1995;66:350-359.
  49. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000;119:1324-1332. https://doi.org/10.1053/gast.2000.19286
  50. Andersen DK, Topazian MD. Pancreatic head excavation: a variation on the theme of duodenum-preserving pancreatic head resection. Arch Surg 2004;139:375-379. https://doi.org/10.1001/archsurg.139.4.375
  51. Ho HS, Frey CF. The Frey procedure: local resection of pancreatic head combined with lateral pancreaticojejunostomy. Arch Surg 2001;136:1353-1358. https://doi.org/10.1001/archsurg.136.12.1353
  52. Ho HS, Frey CF. The Frey procedure: combined local resection of the head of the pancreas with longitudinal pancreaticojejunostomy. Operat Tech Gen Surg 2002:153-167.
  53. Farkas G, Leindler L, Daroczi M, Farkas G Jr. Organpreserving pancreatic head resection in chronic pancreatitis. Br J Surg 2003;90:29-32. https://doi.org/10.1002/bjs.4016
  54. Farkas G, Leindler L, Daroczi M, Farkas G Jr. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy. Langenbecks Arch Surg 2006;391:338-342. https://doi.org/10.1007/s00423-006-0051-7
  55. Buchler MW, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am Surg 1995;169:65-69. https://doi.org/10.1016/S0002-9610(99)80111-1
  56. Strate T, Taherpour Z, Bloechle C, et al. Long-term followup of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005;241:591-598. https://doi.org/10.1097/01.sla.0000157268.78543.03
  57. Koninger J, Seiler CM, Sauerland S, et al. Duodenumpreserving pancreatic head resection: a randomized controlled trial comparing the original Beger procedure with the Berne modification (ISRCTN No. 50638764). Surgery 2008;143:490-498. https://doi.org/10.1016/j.surg.2007.12.002
  58. Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE. Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 1998;228:771-779. https://doi.org/10.1097/00000658-199812000-00008
  59. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized trial. Ann Surg 1995;221:350-358. https://doi.org/10.1097/00000658-199504000-00004
  60. Riediger H, Adam U, Fischer E, et al. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007;11:949-959. https://doi.org/10.1007/s11605-007-0155-6
  61. Izbicki JR, Bloechle C, Knoefel WT, et al. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg 1997;68:369-377. https://doi.org/10.1007/s001040050200
  62. Shrikhande SV, Kleeff J, Friess H, Buchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006;10:227-233. https://doi.org/10.1016/j.gassur.2005.09.004
  63. Strate T, Bachmann K, Busch P, et al. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 2008;134:1406-1411. https://doi.org/10.1053/j.gastro.2008.02.056
  64. Muller MW, Friess H, Beger HG, et al. Gastric emptying following pylorus-preserving Whipple and duodenumpreserving pancreatic head resection in patients with chronic pancreatitis. Am J Surg 1997;173:257-263. https://doi.org/10.1016/S0002-9610(96)00402-3
  65. Muller MW, Friess H, Martin DJ, Hinz U, Dahmen R, Buchler MW. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg 2008;95: 350-356. https://doi.org/10.1002/bjs.5960
  66. Najarian JS, Sutherland DE, Baumgartner D, et al. Total or near total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis. Ann Surg 1980;192:526-542. https://doi.org/10.1097/00000658-198010000-00011
  67. Farney AC, Najarian JS, Nakhleh RE, et al. Autotransplantation of dispersed pancreatic islet tissue combined with total or near-total pancreatectomy for treatment of chronic pancreatitis. Surgery 1991;110:427-437.
  68. Robertson RP, Lanz KJ, Sutherland DE, Kendall DM. Prevention of diabetes for up to 13 years by autoislet transplantation after pancreatectomy for chronic pancreatitis. Diabetes 2001;50:47-50. https://doi.org/10.2337/diabetes.50.1.47
  69. Rastellini C. Donor and recipient selection in pancreatic islet transplantation. Curr Opin Organ Transplant 2002;7:196-202. https://doi.org/10.1097/00075200-200206000-00016
  70. Rickels MR, Schutta MH, Markmann JF, Barker CF, Naji A, Teff KL. {beta}-cell function following human islet transplantation for type 1 diabetes. Diabetes 2005;54:100-106. https://doi.org/10.2337/diabetes.54.1.100
  71. Shapiro AM, Ricordi C, Hering BJ, et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med 2006;355:1318-1330. https://doi.org/10.1056/NEJMoa061267
  72. Robertson GS, Dennison AR, Johnson PR, London NJ. A review of pancreatic islet autotransplantation. Hepatogastroenterology 1998;45:226-235.
  73. Ray BS, Console AD. Evaluation of total sympathectomy. Ann Surg 1949;130:652-671. https://doi.org/10.1097/00000658-194910000-00008
  74. Rack FJ, Elkins CW. Experiences with vagotomy and sympathectomy in the treatment of chronic recurrent pancreatitis. AMA Arch Surg 1950;61:937-943. https://doi.org/10.1001/archsurg.1950.01250020945015
  75. Hammond B, Vitale GC, Rangnekar N, Vitale EA, Binford JC. Bilateral thoracoscopic splanchnicectomy for pain control in chronic pancreatitis. Am Surg 2004;70:546-549.
  76. Buscher HC, Jansen JB, van Dongen R, Bleichrodt RP. Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg 2002;89:158-162.
  77. Baghdadi S, Abbas MH, Albouz F, Ammori BJ. Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis. Surg Endosc 2008;22:580-588. https://doi.org/10.1007/s00464-007-9730-x
  78. Maher JW, Johlin FC, Pearson D. Thoracoscopic splanchnicectomy for chronic pancreatitis pain. Surgery 1996;120:603-609 https://doi.org/10.1016/S0039-6060(96)80006-7
  79. Howard TJ, Swofford JB, Wagner DL, Sherman S, Lehman GA. Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis. J Gastrointest Surg 2002;6:845-852. https://doi.org/10.1016/S1091-255X(02)00123-3
  80. Lillemoe KD, Cameron JL, Kaufman HS, Yeo CJ, Pitt HA, Sauter PK. Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 1993;217:447-455. https://doi.org/10.1097/00000658-199305010-00004
  81. Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasoundand computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999;94:900-905. https://doi.org/10.1111/j.1572-0241.1999.01042.x

피인용 문헌

  1. Recent Advances in Management of Chronic Pancreatitis vol.66, pp.3, 2012, https://doi.org/10.4166/kjg.2015.66.3.144