目的 探討胰腺中段切除術(shù)在治療胰腺頸體部良性腫瘤中的臨床意義。
方法 回顧性分析筆者所在醫(yī)院胰膽外科2007年2月1日至2012年2月1日期間行胰腺中段切除術(shù)的29例患者的臨床資料。
結(jié)果 29例病例無(wú)圍手術(shù)期死亡,手術(shù)時(shí)間為(165±45) min (125~270min);術(shù)中出血量為(173±88) mL (50~450mL);術(shù)后病理報(bào)告均為良性腫瘤。術(shù)后出現(xiàn)不同程度胰瘺10例(A級(jí)9例,B級(jí)1例),均經(jīng)非手術(shù)治療治愈;術(shù)后出現(xiàn)胰腺遠(yuǎn)側(cè)斷面活動(dòng)性出血1例,經(jīng)二次手術(shù)止血,效果仍欠佳,遂行第三次手術(shù),剖腹探查見(jiàn)胰腸吻合口漏、胰腸吻合口出血,故行胰體尾加脾切除術(shù),術(shù)后恢復(fù)良好,痊愈出院。29例患者中獲隨訪21例,隨訪時(shí)間3個(gè)月~4年,平均16個(gè)月,均未出現(xiàn)糖尿病等相關(guān)并發(fā)癥。
結(jié)論 胰腺中段切除術(shù)是治療胰腺頸部及體部良性腫瘤及低度惡性腫瘤的一種合理術(shù)式,可較好地保存術(shù)后胰腺的內(nèi)、外分泌功能,提高患者的生活質(zhì)量。
引用本文: 張和,孫備,白雪巍,陳華,李軍,譚宏濤,姜洪池. 胰腺中段切除術(shù)29例臨床分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(9): 1045-1048. doi: 復(fù)制
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2. | 徐進(jìn), 戴顯偉,卜獻(xiàn). 胰腺中段切除術(shù)(附15例報(bào)道)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6):478-480. |
3. | Muller MW, Friess H, Kleeff J, et al. Middle segmental pancre-atic resection:an option to treat brnign pancreatic body lesions[J]. Ann Surg, 2006, 244(6):909-918. |
4. | Asanuma Y, Koyama K, Saito K, et al. An appraisal of segmentalpancreatetomy for benign tumors of the pancreatic body:a report of two cases[J]. Surg Today, 1993, 23(8):733-736. |
5. | Iacono C, Bortolasi L, Facci E, et al. The Dagradi-Serio-Iacono operation central pancreatectomy[J]. J Gastrointest Surg, 2007, 11(3):364-376. |
6. | Takeyoshi I, Ohwada S, Nakamura S, et al. Segmental pancreatectomy for mucinproducing pancreatic tumors[J]. Hepatogastroenterology, 1999, 46(28):2585-2588. |
7. | Roggin KK, Rudloff U, Blumgart LH, et al. Centralpancreatectomy revisited[J]. J Gastrointest Surg, 2006, 10(6):804-812. |
8. | Christein JD, Smoot RL, Farnell MB. Centralpancreatectomy:a technique for the resection of pancreaticneck lesions[J]. Arch Surg, 2006, 141(3):293-299. |
9. | Rotellar F, Pardo F, Montiel C, et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy:a consecutive ninecase series at a single institution[J]. Ann Surg, 2008, 247(6):938-944. |
10. | Reber HA. Middle pancreatectomy:why I rarely do it?[J]. J Gastrointest Surg, 2007, 11(6):730-732. |
11. | Efron DT, Lillemoe KD, Cameron JL, et al. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology[J]. J Gastrointest Surg, 2004, 8(5):532-538. |
12. | Crippa S, Bassi C, Warshaw AL, et al. Middle pancreatectomy:indications, short- and long-term operative outcomes[J]. Ann Surg, 2007, 246(1):69-76. |
13. | Shimada K, Sakamoto Y, Esaki M, et al. Role of medial pancre-atectomy in the management of intraductal papillary mucinous neo-plasms and islet cell tumors of the pancreatic neck and body[J]. Dig Surg, 2008, 25(1):46-51. |
14. | Iacono C, Bortolasi L, Serio G. Indications and technique of central pancreatectomy-early and late results[J]. Langenbecks Arch Surg, 2005, 390(3):266-271. |
15. | Sperti C, Pasquali C, Ferronato A, et al. Median pancreatectomy for tumors of the neck and body of the pancreas[J]. J Am Coll Surg, 2000, 190(6):711-716. |
16. | Balzano G, Zerbi A, Veronesi P, et al. Surgical treatment of benign and borderline neoplasms of the pancreatic body[J]. Dig Surg, 2003, 20(6):506-510. |
17. | 吳文銘, 趙玉沛, 廖泉, 等. 胰腺節(jié)段切除術(shù)在胰腺良性腫瘤治療中的應(yīng)用[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(1):50-52. |
18. | Okano K, Kakinoki K, Yachida S, et al. A simple and safe panc-reas transection using a stapling device for a distal pancreatectomy[J]. J Hepatobiliary Pancreat Surg, 2008, 15(4):353-358. |
19. | Kleef J, Diener MK, Z’graggen K, et al. Distal pancreatectomy risk factors for surgical failure in 302 consecutive cases[J]. Ann Surg, 2007, 245(4):573-582. |
20. | 陳實(shí), 劉國(guó)華, 鄧俠興, 等. 胰腺中段節(jié)段性切除術(shù)(附40例報(bào)告)[J]. 中國(guó)實(shí)用外科雜志, 2010, 30(9):777-779. |
21. | 苗毅, 蔣奎榮, 徐澤寬. 中段胰腺切除治療胰腺良性或低度惡性腫瘤[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(5):346-349. |
22. | Oida T, Mimatsu K, Kawasaki A, et al. Transduodenal pancreaticjuice drainage for preventing pancreatic fistula formation after distalpancreatectomy[J]. Hepatogastroenterology, 2011, 58(105):177-182. |
23. | 沈柏用, 詹茜, 鄧俠興, 等. 機(jī)器人手術(shù)系統(tǒng)在胰腺中段切除術(shù)中的應(yīng)用[J]. 腹腔鏡外科雜志, 2012, 17(7):481-484. |
24. | Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic middle pancreatectomy[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(2):135-139. |
25. | Buchs NC, Addeo P, Bianco FM, et al. Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years:a comparative study[J]. World J Surg, 2010, 34(9):2109-2114. |
- 1. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula:an international study group (ISGPF) definition[J]. J Surg, 2005, 138(1):8-13.
- 2. 徐進(jìn), 戴顯偉,卜獻(xiàn). 胰腺中段切除術(shù)(附15例報(bào)道)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6):478-480.
- 3. Muller MW, Friess H, Kleeff J, et al. Middle segmental pancre-atic resection:an option to treat brnign pancreatic body lesions[J]. Ann Surg, 2006, 244(6):909-918.
- 4. Asanuma Y, Koyama K, Saito K, et al. An appraisal of segmentalpancreatetomy for benign tumors of the pancreatic body:a report of two cases[J]. Surg Today, 1993, 23(8):733-736.
- 5. Iacono C, Bortolasi L, Facci E, et al. The Dagradi-Serio-Iacono operation central pancreatectomy[J]. J Gastrointest Surg, 2007, 11(3):364-376.
- 6. Takeyoshi I, Ohwada S, Nakamura S, et al. Segmental pancreatectomy for mucinproducing pancreatic tumors[J]. Hepatogastroenterology, 1999, 46(28):2585-2588.
- 7. Roggin KK, Rudloff U, Blumgart LH, et al. Centralpancreatectomy revisited[J]. J Gastrointest Surg, 2006, 10(6):804-812.
- 8. Christein JD, Smoot RL, Farnell MB. Centralpancreatectomy:a technique for the resection of pancreaticneck lesions[J]. Arch Surg, 2006, 141(3):293-299.
- 9. Rotellar F, Pardo F, Montiel C, et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy:a consecutive ninecase series at a single institution[J]. Ann Surg, 2008, 247(6):938-944.
- 10. Reber HA. Middle pancreatectomy:why I rarely do it?[J]. J Gastrointest Surg, 2007, 11(6):730-732.
- 11. Efron DT, Lillemoe KD, Cameron JL, et al. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology[J]. J Gastrointest Surg, 2004, 8(5):532-538.
- 12. Crippa S, Bassi C, Warshaw AL, et al. Middle pancreatectomy:indications, short- and long-term operative outcomes[J]. Ann Surg, 2007, 246(1):69-76.
- 13. Shimada K, Sakamoto Y, Esaki M, et al. Role of medial pancre-atectomy in the management of intraductal papillary mucinous neo-plasms and islet cell tumors of the pancreatic neck and body[J]. Dig Surg, 2008, 25(1):46-51.
- 14. Iacono C, Bortolasi L, Serio G. Indications and technique of central pancreatectomy-early and late results[J]. Langenbecks Arch Surg, 2005, 390(3):266-271.
- 15. Sperti C, Pasquali C, Ferronato A, et al. Median pancreatectomy for tumors of the neck and body of the pancreas[J]. J Am Coll Surg, 2000, 190(6):711-716.
- 16. Balzano G, Zerbi A, Veronesi P, et al. Surgical treatment of benign and borderline neoplasms of the pancreatic body[J]. Dig Surg, 2003, 20(6):506-510.
- 17. 吳文銘, 趙玉沛, 廖泉, 等. 胰腺節(jié)段切除術(shù)在胰腺良性腫瘤治療中的應(yīng)用[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(1):50-52.
- 18. Okano K, Kakinoki K, Yachida S, et al. A simple and safe panc-reas transection using a stapling device for a distal pancreatectomy[J]. J Hepatobiliary Pancreat Surg, 2008, 15(4):353-358.
- 19. Kleef J, Diener MK, Z’graggen K, et al. Distal pancreatectomy risk factors for surgical failure in 302 consecutive cases[J]. Ann Surg, 2007, 245(4):573-582.
- 20. 陳實(shí), 劉國(guó)華, 鄧俠興, 等. 胰腺中段節(jié)段性切除術(shù)(附40例報(bào)告)[J]. 中國(guó)實(shí)用外科雜志, 2010, 30(9):777-779.
- 21. 苗毅, 蔣奎榮, 徐澤寬. 中段胰腺切除治療胰腺良性或低度惡性腫瘤[J]. 中國(guó)實(shí)用外科雜志, 2008, 28(5):346-349.
- 22. Oida T, Mimatsu K, Kawasaki A, et al. Transduodenal pancreaticjuice drainage for preventing pancreatic fistula formation after distalpancreatectomy[J]. Hepatogastroenterology, 2011, 58(105):177-182.
- 23. 沈柏用, 詹茜, 鄧俠興, 等. 機(jī)器人手術(shù)系統(tǒng)在胰腺中段切除術(shù)中的應(yīng)用[J]. 腹腔鏡外科雜志, 2012, 17(7):481-484.
- 24. Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic middle pancreatectomy[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(2):135-139.
- 25. Buchs NC, Addeo P, Bianco FM, et al. Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years:a comparative study[J]. World J Surg, 2010, 34(9):2109-2114.