慢性胰腺炎-ppt教学课件

《慢性胰腺炎-ppt教学课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、TheEvolutionoftheSurgicalTreatmentofChronicPancreatitis汇报人：柴大海导师：刘杰专业：普外2021/7/121BACKGROUNDOperativeapproachestothetreatmentofchronicpancreatitishaveundergoneadramatictransformationoverthepastfewdecades.Theheadofthepancreashasbecomeuniversallyapprec

2、iatedasthenidusofchronicinflammation.Prospective,randomizedtrialshaverepeatedlyshownthesuperiorityofsurgicaltreatmentovermedicalapproachestomanagement2021/7/122INDICATIONSFORSURGERYPainDuctalhypertension:someanatomicchangesrelatedwithitsuchas：smallcys

3、ts、fociofacinarcellnecrosis、areasofacuteinflammationPeripancreaticsensorynervedamage：inflammatorydamage、neuron-specificproteinaseactivatedreceptor2activation、Cfibers（asubpopulationofsensoryneurons）containpeptideswhichcancauseinflammatorychanges2.Thecompli

4、cationsofchronicpancreatitis2021/7/123TreatmentThemedicaltreatmentofchronicpancreatitis-associatedpainusuallyfailssurgicaltreatmentofchronicpancreatitishasbeenshowntoeliminatepainandreturnpatientstoprediseaseemploymentandquality-of-lifestatus.2021/7/

5、124OperativeproceduresOperativeproceduresaboutchronicpancreatitishavehistoricallybeenclassifiedinto3categories：DecompressionofdiseasedandobstructedpancreaticductsDenervationofthepancreasResectionoftheproximal,distal,ortotalpancreas.Withinthepastfewyea

6、rs,however,acategoryofhybridprocedureshasbeenshowntobesafeandeffective.2021/7/125DECOMPRESSIONPROCEDURESRemovecalculifromWirsung’sduct:transpancreaticrouteortransduodenallythroughthepapillaofVater(ERCPWITHORWITHOUTprolongedpancreaticductstenting)Deco

7、mpressingtheproximalpancreaticanddistalbileductsbysphincteroplastytopreventrecurrentpancreatitiswhichcausedbybiliarystone.2021/7/126Externaldrainageofthepancreaticducttodecompressobstructioncausedbystrictureorcalculus(Fig.1)FIGURE12021/7/127Roux-en-Y

8、,side-to-end,pancreaticojejunostomyThecaudal,end-to-end,pancreaticojejunostomyasadrainageprocedureforchronicpancreatitis(FIG2.)FIGURE2.2021/7/128Longitudinaldecompre-ssionofthebodyandtailofthepancreasintoaRouxlimbofjejunum(Fig.3)FIGURE3.2021/7/129Sid