title: [Typing and surgical treatment choice for pancreatic ductal stone].
abstract: OBJECTIVE
  To explore the improvement of typing and reasonable surgical treatment for pancreatic ductal stone (PDS).
  
  
  METHODS
  Totally 89 patients with pancreatic ductul stone treated underwent surgeries from January 2000 to December 2012 were involved into this study. There were 57 male and 32 female patients, the average age was (52 ± 23) years. According to the magnetic resonance cholangiopancreatography imaging and finding during surgery, pancreatolithiasis was classified into three types: type I, the stones were located in the main pancreatic duct; type II, the stones were located both in main and branch pancreatic duct; type III, the stones were diffusely scattered in the branch pancreatic duct; the position of PDS within pancreatic parenchyma were subtitled. In this group, 43 type I PDS were extracted with endoscopic papillotomy or endoscopic pancreatic sphincterotomy, or pancreatolithotomy plus pancreato-jejunal lateral anastomosis with wide anastomotic stoma; 39 type II cases were treated by pancreatolithotomy plus pancreato-jejunal lateral anastomosis or/and resection of pancreatic section; 7 type III PDS were managed with resection of pancreatic section.
  
  
  RESULTS
  All surgeries were performed successfully. Among complications, 6 cases (6.7%) were pancreatic leakage which recovered after systematic non-surgical treatment, 2 cases (2.2%) were anastomotic bleeding which led to 1 death, 6 cases (6.7%) were residual pancreatolithiasis in branch pancreatic duct type. Seventy-eight patients were followed up for 6 to 131 months, 57 cases were still alive so far. Five cases were intermittent abdominal pain, 7 cases were diabetes resulted from 2 subtotal pancreatectomy and 5 distal pancreatectomy, 5 cases occurred pancreatolithiasis recurrence and 3 underwent secondary surgeries.
  
  
  CONCLUSIONS
  The basis of this modified typing of pancreatolithiasis is the position of stone in pancreatic duct rather than pancreas parenchyma. It is more important and valuable for surgical principle of taking stones out completely and maintaining pancreatic function.
authors.affiliation: Department of Biliary & Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Email: chenyongjun45@126.com.
authors.forename: Yong-jun
authors.initials: YJ
authors.lastname: Chen
authors.forename: Rui
authors.initials: R
authors.lastname: Tian
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.forename: Cheng-jian
authors.initials: CJ
authors.lastname: Shi
authors.forename: Ren-yi
authors.initials: RY
authors.lastname: Qin
authors.forename: Sheng-quan
authors.initials: SQ
authors.lastname: Zou
mesh_terms: D000328:Adult; D002137:Calculi / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000145:classification / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology; D016717:Sphincterotomy, Endoscopic; D055815:Young Adult