RESULT OF SURGICAL TREATMENT FOR CHRONIC PANCREATITIS

Of 32 patients with chronic pancreatitis who could be followed for more than six months postoperatively, those showing no dilatation of the pancreatic duct, defined as having a main pancreatic duct less than 6mm in diameter, underwent an analysis of their clinical pictures and operative results to investigate a desirable method of surgical treatment for this condition. Of eight patients with an absence of pancreatic duct dilatation, localized lesions were found in five. These were disorders of pancreatic endocrine and exocrine functions and pancreatic fibrosis, the dogree being mild in most cases. In one patient with lesions in the head of the pancreas, plastic surgery of the papillopancreatic duct orifice for the purpose of removing pain seemed to be sufficient because there was no stenosis of the main pancreatic duct or other accessory lesions. In four patients with lesions in the caudal area, which were accompanied by accessory lesions such as stenosis of the main pancreatic duct at that area, cyst, and abscess, pain removal procedure or partial pancreatectomy on the caudal side for the accessory lesions was considered necessary. Diffuse lesions were found in three patients, who also showed moderate or severe disorders of pancreatic endocrine and exocrine functions and pancreatic fibrosis. In such cases, extensive pancreatectomy including total pancreatectomy, is usually indicated. However, there are some doubts about the propriety of extensive pancreatectomy only for the purpose of removing pain. In this regard, we consider infusion of a sclerosing agent into the main pancreatic duct and total excision of the pancreatic plexus. The former method, however, has various problems to solve before its clinical application, requiring development of a new sclerosing agent. As for total excision of the pancreatic plexus, we have so far experienced only one patient, who has been followed up for a relatively short period of three months, with an extremely favorable course of postoperative conditions. It seems that this technique is a nromising surgical method for this condition.