Surgical Treatment of Chronic Pancreatitis with Ductal Hypertension without Ductal Dilatation

A.V. Klimenko, V.N. Klimenko, A.A. Steshenko, V.A. Tumansky, I.S. Kovalenko

Abstract


Some patients with chronic pancreatitis shows ductal hypertension without significant ductal dilatation, which causes difficulties in the choice of treatment (conservative and surgical), and the method of surgery (parenchyma-preserving, resection).
Material and methods. One hundred and ten patients with chronic pancreatitis were operated. Among them 38 (34.5 %) had severe ductal hypertension without significant ductal dilatation. Average age was 48 years old, 34 males, 4 females. Among chronic pancreatitis forms (by A.A. Shalimov) 8 patients had calculous pancreatitis (8/38; 21.0 %), 17 persons had pseudotumor one (17/38; 44.7 %), 5 patients had cystic fibrosis (5/38; 13.2 %), 8 persons had degenerative fibrosis involving annexa (8/38; 21.1 %). Alcohol genesis was identified in 33 (33/38; 86.8 %) patients, idiopathic in 5 (5/38; 13.2 %). The patients were undergone ultrasound observation, CT-scan, endoscopy, ERCP; there were defined tumor marker CA 19-9, endogenous insulin, glycated hemoglobin, C-peptide, feces pancreatic elastase-1. there was conducted hystochemical and immunohystochemical analysis of intraoperative sections of the head, body and tail of pancreas. All the patients were undergone parenchyma-preserving surgery: longitudinal total pancreatic wirsungoduodenopapillotomy with longitudinal Roux-en-Y pancreaticojejunoduodenostomy.
Results and discussion. The clinical, intraoperative and morphological data in these patients were analyzed. It is shown that the phenomenon of «ductal hypertension without ductal dilatation» in chronic pancreatitis forms due to the development of total periductal stromal fibrosis, which limits the dilatation of the ducts from the primary acinar to the main pancreatic duct. It was found that α-SMA-positive stellate cells are activated in response to the progression of ductal hypertension, their number has increased around the large and medium-sized pancreatic ducts. They aggressively penetrate from the area of periductal fibrosis in the interlobular stroma of the pancreas to form interlobular fibrous septa-tubules, as if cementing the stromal structure of the body, giving it a maximum stiffness (syndrome of mutual aggravation). As a result, the development of a combined periductal stromal fibrosis is characterized by its high severity. This group of patients is indicated to parenchyma-preserving type of operation: a longitudinal total pancreatic wirsungoduodenopapillotomy with longitudinal Roux-en-Y pancreaticojejunoduodenostomy or isolated anastomosis. A long-term result of this type of surgery in patients with chronic pancreatitis shows high quality of life on all scales of the international questionnaire MOS SF-36, especially if surgical intervention was performed timely (before the development of the exocrine and endocrine insufficiency moderate severe).
Conclusion. Prompt surgical treatment as the parenchyma-preserving operation — longitudinal total pancreatic wirsungoduodenopapillotomy with longitudinal Roux-en-Y pancreaticojejunoduodenostomy is indicated for the chronic pancreatitis patients with ductal hypertension without ductal dilatation.


Keywords


chronic pancreatitis; ductal hypertension; periductal fibrosis; stellate cells; surgical treatment

References


Губергриц Н.Б. Метаболическая панкреатология / Н.Б. Губергриц, А.Н. Казюлин. — Донецк: Лебедь, 2011. — 514 с.

Резекция головки поджелудочной железы при хроническом панкреатите. Как делать и как называть? (аналитический обзор) / В.И. Егоров, В.А. Вишневский, А.Т. Щастный [и др.] // Хирургия. — 2009. — № 8. — С. 57-66.

Хирургическая анатомия поджелудочной железы / В.М. Копчак, А.Ю. Усенко, К.В. Копчак, А.И. Зелинский. — К.: Аскания, 2011. — 141 с.

Хирургическое лечение хронического панкреатита / В.М. Копчак, К.В. Копчак, Л.А. Перерва,

А.В. Дувалко // Здоров’я України. — 2012. — № 1(7). —

С. 18-19.

Хронический панкреатит: мифы и реальность. Современные аспекты фармакотерапии гастроэнтерологических заболеваний / И.В. Маев, Ю.А. Кучерявый, А.Б. Москалева. — М.: Бионика, 2012. — С. 220-229.

Beger H.G. Diseases of the Pancreas / Beger H.G., Matsuno S., Cameron J.L. — Berlin; Heidelberg: Springer-Verlag, 2008. — 905 p.

Farkas G. Surgical treatment of chronic pancreatitis / Farkas G. // Magy Seb. — 2011. — № 64(2). — Р. 63-68.

Kloppel G. Chronic pancreatitis, pseudotumors and other tumоr-like lesions / Kloppel G. // Modern Pathology. — 2007. — № 20. — Р. 113-131.

Long-term quality of life after surgery for chronic pancreatitis / Van Loo E.S., van Baal M.C., Goosen H.G., Ploeg K.J. [et al.] // Br. J. Surg. — 2010. — № 97(7). — Р. 1079-1086.

Strobel O. Surgical therapy of chronic pancreatitis: indications, techniques and results / Strobel O., Buchler M.W., Werner J. // Int. J. Surg. — 2009. — № 7(4). — Р. 305-312.




DOI: https://doi.org/10.22141/1997-2938.1.20.2013.87548

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