目的 了解胰十二指肠切除术中良性病例所占比例，分析其病变类型，探讨术前、术中诊断及其它治疗方式的可行性。方法 回顾性分析我院1996～2001年期间206例术前诊断为胰头或壶腹周围恶性肿瘤而作胰十二指肠切除术病例中，术后病理诊断为良性病变者23例的临床、病理资料。结果 术后病理检查发现慢性胰腺炎14例，胰头囊腺瘤2例，十二指肠乳头异位胰腺l例，十二指肠乳头良性腺瘤4例，胆总管下段炎性狭窄2例。良性病变占整个胰十二指肠切除术病例的11.2%。结论 在作胰十二指肠切除术的良性病变巾慢性胰腺炎占大多数。术中取活检作冰冻切片病理检查是鉴别良、恶性病变的最有效方法。对这些良性病变可选择保守治疗或行较小的局部切除术。

AIM: To explore the etlology, pathogenesis, diagnosis, and treatment of postsurgical gastroparesis syndrome (PGS) after pancreatic cancer cryotherapy (PCC) or pancreatico-duodenccomy (PD), and to analyze the correlation between the multiple factors and PGS caused by the operations. METHODS: Clinical data of 210 patients undergoing PD and 46 undergoing PCC were analyzed retrospectively. RESULTS: There were 31 (67%, 31/46) patients suffering PGS in PCC group, including 29 with pancreatic head and uncinate tumors and 2 with pancreatic body and tall tumors. Ten patients (4.8%, 10/210) developed PGS In PD group, which had a significantly lower Incldence of PGS than PCC group (χ=145, P<0.001). In PCC group, 9 patients with PGS were managed with non-operative treatment (drugs, dlet, nasogastric sucion, etc.), and one received reoperation at the 16th day, but the symptoms were not relieved. In PD group, all the patients with PGS were managed with non-operative treatment. The PGS in patients undergoing PCC had close assoclation with PCC, tumor location, but not with age, gender, obstructive jaundice, dypoproteinemia, preoperative gastric outlet obstruction and the type and number of gastric biliary tract operations. The mechanisms of PGS caused by PD were similar to those of PGS following gastrectomy. The damage to interstitial cells of Cajal might play a role in the pathogenesis of PGS after PCC, for which multiple factors were posslbly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the panctaatico-duodenal regions or reduced circulating levels of motilin. CONCLUSION: PGS after PCC or PD is induced by multiple factors and the exact mechanisms, which might differ between these two operations, remain unknown. Radiography of the upper gastrointestinal tract and gastroscopy are main diagnostic for PGS, and reoperation should be avolded in patients whith PGS caused by PCC.