保留十二指肠全胰头切除术2例报告:附视频
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摘要
随着损伤控制性手术和器官功能保留理念的广泛接受,对于胰头良性和低度恶性肿瘤目前多主张行保留十二指肠胰头切除术(DPPHR),但该手术局部解剖及血供复杂,手术操作难度较大,术后易发生胆道和十二指肠缺血等并发症,国内外报道的例数较少。在这里我们报道2例保留十二指肠全胰头切除术,其中1例胰头浆液性囊腺瘤患者实施胰头全切除、胰胃吻合术;1例胰头肿块型胰腺炎患者行胰头全切除、胰空肠吻合术。病例1术后1周发生急性上消化道出血,经制酸、止血、生长抑素等治疗后血止痊愈出院;病例2术后发生A级胰瘘,经引流保守治疗后痊愈出院。DPPHR的操作要点在于完整切除胰头及病变组织、保障十二指肠和胆总管下端血供,防止十二指肠和胆道缺血性损伤。
With the wide acceptance of the concept of damage control surgery and organ function preservation,duodenum-preserving pancreatic head resection(DPPRH)is commonly advocated to patients with benign and low malignant neoplasms.But because of complex local anatomy and blood supply,difficulty of operation,and high postoperative complications such as biliary and duodenal ischemia,the case reports are rare.We described two cases of DPPHR here,with total pancreatic head resection and pancreastic gastric anastomosis performed for one patient with serous cystadenoma of the pancreatic head,and total pancreatic head resection and pancreaticojejunostomy performed for the other patient of pancreatitis with pancreatic head mass.For case 1,acute upper digestive tract hemorrhage occurred one week after operation,and was cured and discharged after treatment with acid,hemostasis and somatostatin.Case 2 had Grade A pancreatic fistula complication after the operation,and was recovered and discharged after conservative treatment.The main points of the DPPHR procedure is the en bloc removal of the pancreatic head and the pathologic tissue,ensuring the blood supply of the duodenum and the inferior extremity of the common bile duct,to prevent the ischemia damage of the duodenum and bile duct.
With the wide acceptance of the concept of damage control surgery and organ function preservation,duodenum-preserving pancreatic head resection(DPPRH)is commonly advocated to patients with benign and low malignant neoplasms.But because of complex local anatomy and blood supply,difficulty of operation,and high postoperative complications such as biliary and duodenal ischemia,the case reports are rare.We described two cases of DPPHR here,with total pancreatic head resection and pancreastic gastric anastomosis performed for one patient with serous cystadenoma of the pancreatic head,and total pancreatic head resection and pancreaticojejunostomy performed for the other patient of pancreatitis with pancreatic head mass.For case 1,acute upper digestive tract hemorrhage occurred one week after operation,and was cured and discharged after treatment with acid,hemostasis and somatostatin.Case 2 had Grade A pancreatic fistula complication after the operation,and was recovered and discharged after conservative treatment.The main points of the DPPHR procedure is the en bloc removal of the pancreatic head and the pathologic tissue,ensuring the blood supply of the duodenum and the inferior extremity of the common bile duct,to prevent the ischemia damage of the duodenum and bile duct.
引文
1王春友.胰头部良性和低恶性病变手术治疗的器官保留与损伤控制[J].中国实用外科杂志,2009,29(8):622-624.
2 Beger HG,Rau BM,Poch B.Duodenum preserving subtotal and total pancreatic head resections for inflammatory and cystic neoplastic lesions of the pancreas[J].J Gastrointest Surg,2008,12(6):1127-1132.
3 Glazer ES,Amini A,Jie T,et al.Recognition of complications after pancreaticduodenectomy for cancer determines in patient mortality[J].JOP,2013,14(6):626-631.
4 Aspelund G,Tepazian MD,Lee JH,et al.Improved outcomes for benign disease with limited pancreatic head resection[J].J Gastrointest Surg,2005,9(3):400-409.
5谢彬,王槐志.保留十二指肠胰头切除术的手术要点及适应证把握[J].肝胆外科杂志,2014,22(1):5-7.
6 Varghese TK,Bell RH.Duodenum-preserving head resection for chronic pancreatitis:an institutional experience and national survey of usage[J].Surgery,2007,142(4):588-593.
7 Beger HG,Siech M,Poch B.Duodenum-preserving total pancreatic head resection:an organ-sparing operation technique for cystic neoplasms and non-invasive malignant tumors[J].Chirurg,2013,84(5):412-420.
8李清.胰头及胰十二指肠血管区的临床应用解剖研究[J].临床和实验医学杂志,2006,10(5):1534-1535.
9陈焕伟,李梅生,李杰原,等.中段胰腺切除术治疗胰颈体良性和交界性肿瘤分析[J/CD].中华普通外科学文献:电子版,2010,4(3):255-257.
10王文涛.胰头十二指肠切除术后胰胃吻合和胰肠吻合的选择[J/CD].中华普通外科学文献:电子版,2009,3(3):240.
11 Strobel O,Buchler MW,Werner J.Surgical therapy of chronic pncreatitis:indications,techniques and results[J].Int J Surg,2009,7(4):305-312.
2 Beger HG,Rau BM,Poch B.Duodenum preserving subtotal and total pancreatic head resections for inflammatory and cystic neoplastic lesions of the pancreas[J].J Gastrointest Surg,2008,12(6):1127-1132.
3 Glazer ES,Amini A,Jie T,et al.Recognition of complications after pancreaticduodenectomy for cancer determines in patient mortality[J].JOP,2013,14(6):626-631.
4 Aspelund G,Tepazian MD,Lee JH,et al.Improved outcomes for benign disease with limited pancreatic head resection[J].J Gastrointest Surg,2005,9(3):400-409.
5谢彬,王槐志.保留十二指肠胰头切除术的手术要点及适应证把握[J].肝胆外科杂志,2014,22(1):5-7.
6 Varghese TK,Bell RH.Duodenum-preserving head resection for chronic pancreatitis:an institutional experience and national survey of usage[J].Surgery,2007,142(4):588-593.
7 Beger HG,Siech M,Poch B.Duodenum-preserving total pancreatic head resection:an organ-sparing operation technique for cystic neoplasms and non-invasive malignant tumors[J].Chirurg,2013,84(5):412-420.
8李清.胰头及胰十二指肠血管区的临床应用解剖研究[J].临床和实验医学杂志,2006,10(5):1534-1535.
9陈焕伟,李梅生,李杰原,等.中段胰腺切除术治疗胰颈体良性和交界性肿瘤分析[J/CD].中华普通外科学文献:电子版,2010,4(3):255-257.
10王文涛.胰头十二指肠切除术后胰胃吻合和胰肠吻合的选择[J/CD].中华普通外科学文献:电子版,2009,3(3):240.
11 Strobel O,Buchler MW,Werner J.Surgical therapy of chronic pncreatitis:indications,techniques and results[J].Int J Surg,2009,7(4):305-312.