保留十二指肠胰头切除术的临床应用探讨
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摘要
目的探讨保留十二指肠的胰头切除术(DPPHR)的适应证和疗效。方法回顾性分析2013年1月-2017年2月于福建省立医院肝胆外科行DPPHR的17例患者的临床资料,其中慢性胰腺炎合并胰管结石6例,慢性胰腺炎合并胰腺假性囊肿2例,胰头实性假乳头状瘤3例,导管内乳头状黏液性肿瘤3例,胰头浆液性囊腺瘤2例,胰头黏液性囊腺瘤1例。结果手术时间200~360 min,平均(304.0±45.3)min,术中失血量50~500 ml,平均(267.5±116.1)ml。无围手术期死亡。术后出现生化漏5例,B级胰瘘2例,无C级胰瘘,胃瘫1例,均经保守治疗后痊愈出院。术后住院时间17~78 d,平均(30.8±14.3)d。手术后对17例患者随访2个月~4年,未见肿瘤复发,无手术后新发糖尿病、消化不良以及胆总管狭窄等。结论 DPPHR在确保肿瘤完全切除的基础上,能够降低手术创伤以及并发症发生率,缩减手术时间以及住院时间,相较于胰十二指肠切除术,DPPHR能够较好地保留胰腺内、外分泌功能,更好地改善患者的术后生活质量。
Objective To investigate the indications and therapeutic effect of duodenum-preserving pancreatic head resection( DPPHR).Methods A retrospective analysis was performed for the clinical data of 17 patients who underwent DPPHR in Fujian Provincial Hospital from January 2013 to February 2017. Among these patients,6 had chronic pancreatitis with pancreatic duct stones,2 had chronic pancreatitis with pancreatic pseudocyst,3 had solid pseudopapillary tumor of the pancreatic head,3 had intraductal papillary mucinous neoplasm,2 had serous cystadenoma of the pancreatic head,and 1 had mucinous cystadenoma of the pancreatic head. Results The time of operation was 200-360 minutes( mean 304. 0 ± 45. 3 minutes),and the intraoperative blood loss was 50-500 ml( mean 267. 5 ± 116. 1 ml). No patient died in the perioperative period. After surgery,5 experienced biochemical leak,2 experienced grade B pancreatic fistula,no patient experienced grade C pancreatic fistula,and 1 experienced gastroplegia; all these patients were cured and discharged after conservative treatment. The length of postoperative hospital stay was 17-78 days( mean 30. 8 ± 14. 3 days). The 17 patients were followed up for 2 months to 4 years after surgery,and no patient experienced tumor recurrence,new-onset diabetes,dyspepsia,or common bile duct stenosis after surgery. Conclusion Besides ensuring the complete resection of tumor,DPPHR can reduce the incidence rate of surgical trauma and complications and shorten the time of operation and the length of hospital stay. Compared with pancreaticoduodenectomy,DPPHR can better preserve the endocrine and exocrine functions of the pancreas and improve patients' postoperative quality of life.
Objective To investigate the indications and therapeutic effect of duodenum-preserving pancreatic head resection( DPPHR).Methods A retrospective analysis was performed for the clinical data of 17 patients who underwent DPPHR in Fujian Provincial Hospital from January 2013 to February 2017. Among these patients,6 had chronic pancreatitis with pancreatic duct stones,2 had chronic pancreatitis with pancreatic pseudocyst,3 had solid pseudopapillary tumor of the pancreatic head,3 had intraductal papillary mucinous neoplasm,2 had serous cystadenoma of the pancreatic head,and 1 had mucinous cystadenoma of the pancreatic head. Results The time of operation was 200-360 minutes( mean 304. 0 ± 45. 3 minutes),and the intraoperative blood loss was 50-500 ml( mean 267. 5 ± 116. 1 ml). No patient died in the perioperative period. After surgery,5 experienced biochemical leak,2 experienced grade B pancreatic fistula,no patient experienced grade C pancreatic fistula,and 1 experienced gastroplegia; all these patients were cured and discharged after conservative treatment. The length of postoperative hospital stay was 17-78 days( mean 30. 8 ± 14. 3 days). The 17 patients were followed up for 2 months to 4 years after surgery,and no patient experienced tumor recurrence,new-onset diabetes,dyspepsia,or common bile duct stenosis after surgery. Conclusion Besides ensuring the complete resection of tumor,DPPHR can reduce the incidence rate of surgical trauma and complications and shorten the time of operation and the length of hospital stay. Compared with pancreaticoduodenectomy,DPPHR can better preserve the endocrine and exocrine functions of the pancreas and improve patients' postoperative quality of life.
引文
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[7]RIEDIGER H,ADAM U,UTZOLINO S,et al.Perioperative outcome after pancreatic head resection:a 10-year series of a specialized surgeon in a university hospital and a community hospital[J].J Gastrointest Surg,2014,18(8):1434-1440.
[8]LIU JZ,HUANG XY.Duodenum-preserving resection of pancreatic head[J].J Hepatopancreatobiliary Surg,2010,22(4):342-345.(in Chinese)刘嘉哲,黄新余.保留十二指肠胰头切除术[J].肝胆胰外科杂志,2010,22(4):342-345.
[9]HAN DE,SUN QF,HU ZL,et al.Surgical vascular anatomy basis for duodenum-preserving resection of pancreatic head[J].Chin J Gen Surg,2004,19(3):150-152.(in Chinese)韩德恩,孙庆峰,胡占良,等.保留十二指肠的胰头切除术实用外科血管解剖学研究[J].中华普通外科杂志,2004,19(3):150-152.
[2]TSUTSUMI K,OHTSUKA T,MORI Y,et al.Analysis of lymph node metastasis in pancreatic neuroendocrine tumors(PNETs)based on the tumor size and hormonal production[J].J Gastroenterol,2012,47(6):678-685.
[3]CUI M,LIAO Q.Selection of different procedures in the treatment of pancreatic pseudocyst[J/CD].Chin J Hepatic Surg:Electronic Edition,2016,5(6):355-357.(in Chinese)崔铭,廖泉.胰腺假性囊肿治疗方式选择[J/CD].中华肝脏外科手术学电子杂志,2016,5(6):355-357.
[4]BEGER HG,NAKAO A,MAYER B,et al.Duodenum-preserving total and partial pancreatic head resection for benign tumors——systematic review and meta-analysis[J].Pancreatology,2015,15(2):167-178.
[5]BEGER HG,SIECH M,POCH B,et al.Limited surgery for benign tumours of the pancreas:a systematic review[J].World J Surg,2015,39(6):1557-1566.
[6]JIANG KY,WU K,LIAO YP,et al.A meta-analysis of surgery treatment of chronic pancreatitis with an inflammatory mass in the head of pancreas:duodenum-preserving pancreatic head resection versus pancreatoduodenectomy[J].Chin J Surg,2014,52(9):668-674.(in Chinese)蒋康怡,吴柯,廖玉平,等.保留十二指肠的胰头切除术与胰十二指肠切除术治疗胰头肿块型胰腺炎的Meta分析[J].中华外科杂志,2014,52(9):668-674.
[7]RIEDIGER H,ADAM U,UTZOLINO S,et al.Perioperative outcome after pancreatic head resection:a 10-year series of a specialized surgeon in a university hospital and a community hospital[J].J Gastrointest Surg,2014,18(8):1434-1440.
[8]LIU JZ,HUANG XY.Duodenum-preserving resection of pancreatic head[J].J Hepatopancreatobiliary Surg,2010,22(4):342-345.(in Chinese)刘嘉哲,黄新余.保留十二指肠胰头切除术[J].肝胆胰外科杂志,2010,22(4):342-345.
[9]HAN DE,SUN QF,HU ZL,et al.Surgical vascular anatomy basis for duodenum-preserving resection of pancreatic head[J].Chin J Gen Surg,2004,19(3):150-152.(in Chinese)韩德恩,孙庆峰,胡占良,等.保留十二指肠的胰头切除术实用外科血管解剖学研究[J].中华普通外科杂志,2004,19(3):150-152.