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首页> 外文期刊>International Journal of Surgery Case Reports >Combined Puestow and choledocoduodenostomy for concomitant large pancreatic duct and primary choledochal stones: A case series
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Combined Puestow and choledocoduodenostomy for concomitant large pancreatic duct and primary choledochal stones: A case series

机译：Puestow联合胆总管十二指肠造口术并发大胰管和原发性胆总管结石：一个病例系列

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Introduction Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the leading method to manage the patients. But ERCP has difficulties when facing the multiple and large stones Presentation of case Our first case was a 51-years-old man who was admitted to our surgery unit with a diagnosis of chronic pancreatitis. Plain abdominal radiogram, Abdominal MSCT and Magnetic Resonance Cholangiopancreatography (MRCP) showed opacity suspected as stone at the pancreatic duct and distal part of the common bile duct. The second case was a 48-years-old female with the clinical presentation of left upper quadrant pain and history of chronic pancreatitis and intermittent jaundice. Plain abdominal radiogram and MRCP revealed multiple stones in the main pancreatic duct and common bile duct stones. Our third case was female, 60-years-old, who was hospitalized with jaundice and recurrent upper abdominal pain with a history of open cholecystectomy one month previously. Radiologic examination showed multiple stones in the main pancreatic duct and common bile duct. Combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy were performed successfully in all cases. Postoperative follow-up showed good recovery of all patients. Discussion Since ERCP is not proper to be used for multiple and large pancreatic duct stones, we performed a combination of longitudinal pancreatojejunostomy Roux-en-Y and choledoco-duodenostomy to treat the patients and prevent the recurrence. Conclusion The incidence of multiple pancreatic duct stones and large choledochal stones is infrequent. Surgical treatment with combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy is safe and effective to resolve jaundice and recurrent pain caused by chronic pancreatitis.
机译：引言伴有原发性胆总管结石的多发大胰管结石很少见。患者通常表现为复发性黄疸和胰腺炎体征。内镜逆行胰胆管造影（ERCP）是治疗患者的主要方法。但是ERCP在面对多发大结石时会遇到困难。病例介绍我们的第一个病例是一名51岁的男子，他被诊断出患有慢性胰腺炎，被送入我们的手术室。腹部平片，腹部MSCT和磁共振胰胆管造影（MRCP）显示在胰管和胆总管远端疑似结石。第二例是一名48岁的女性，临床表现为左上腹疼痛以及慢性胰腺炎和间歇性黄疸病史。腹部平片和MRCP显示在主胰管和胆总管结石中有多处结石。我们的第三例是60岁的女性，她因黄疸和复发性上腹部疼痛入院，一个月前有开腹胆囊切除术史。影像学检查显示主胰管和胆总管有多处结石。所有病例均成功进行了纵向胰空肠吻合术Roux-en-Y和Choledoco-十二指肠吻合术。术后随访显示所有患者恢复良好。讨论由于ERCP不适合用于多发和大胰管结石，因此我们进行了纵向胰空肠吻合术Roux-en-Y和choledoco-十二指肠吻合术以治疗患者并预防复发。结论多发性胰管结石和大胆总管结石的发生率不高。联合纵向空肠空肠吻合术Roux-en-Y和Choledoco-十二指肠吻合术的手术治疗对于解决慢性胰腺炎引起的黄疸和复发性疼痛是安全有效的。

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