保留胆总管及十二指肠的改良胰头切除术临床研究
|
摘要
目的探讨保留十二指肠的胰头切除术(DPRHP)Berger手术的改进方法,以求取得更好的临床疗效。方法自2013年01月~2016年12月,共收治12例需胰头切除术病人对Berger手术进行改进。采用与Berger术和日本学者Imaizumi与Takada区别而改良的方法,即只保留了胰十二指肠后动脉弓及十二指肠第一穿支血管。结果观察组手术时间、术中失血量、输血比例及术中输血量要明显低于对照组患者,P<0.05。观察组与对照组在术后胰漏、呼吸道感染及吻合口漏等发生率比较,两组差异有统计学意义,P<0.05。结论本改进方法与传统胰十二指肠切除术及Berger手术相比较,优点是既可减小手术创伤,又可保留胆总管及十二指肠,胃、胆、肠排空维持原通道,胰腺内外分泌功能所受影响较小,胆总管的运动及排泄功能不受影响。故本方法更具有优势。
Objective To study the improved method of Berger operation for the preservation of duodenum by head excision(DPRHP)in order to achieve better clinical efficacy.Methods From January 2013 to December 2016.Twelve patients were treated to improve the operation of Berger.We adopted the modified method,which was different from that of Berger and Japanese scholars Imaizumi and Takada.Only the posterior pancreaticoduodenal artery arch and the first perforating branch of the duodenum were preserved.Results The operation time of the observation group,the amount of blood loss,the proportion of blood transfusion and the amount of blood transfusion in the operation were significantly lower than those of the control group,P <0.05.In the observation group and the control group,the incidence of pancreatic leakage,respiratory infection and anastomotic leakage after operation was compared,and the difference between the two groups was statistically significant,P <0.05.Conclusion the improved method and the traditional pancreaticoduodenectomy surgery and Berger comparison,has the advantages of minimal trauma,and can retain the common bile duct and duodenum,gastric emptying,intestinal bile,to maintain the original channel,pancreas function is less affected,bile duct movement and excretion function is not affected.Therefore,this method is more advantageous.
Objective To study the improved method of Berger operation for the preservation of duodenum by head excision(DPRHP)in order to achieve better clinical efficacy.Methods From January 2013 to December 2016.Twelve patients were treated to improve the operation of Berger.We adopted the modified method,which was different from that of Berger and Japanese scholars Imaizumi and Takada.Only the posterior pancreaticoduodenal artery arch and the first perforating branch of the duodenum were preserved.Results The operation time of the observation group,the amount of blood loss,the proportion of blood transfusion and the amount of blood transfusion in the operation were significantly lower than those of the control group,P <0.05.In the observation group and the control group,the incidence of pancreatic leakage,respiratory infection and anastomotic leakage after operation was compared,and the difference between the two groups was statistically significant,P <0.05.Conclusion the improved method and the traditional pancreaticoduodenectomy surgery and Berger comparison,has the advantages of minimal trauma,and can retain the common bile duct and duodenum,gastric emptying,intestinal bile,to maintain the original channel,pancreas function is less affected,bile duct movement and excretion function is not affected.Therefore,this method is more advantageous.
引文
[1]田雨霖.保留十二指肠的胰头切除术[J].中国实用外科杂志,2008,28(5):399-402.
[2]今泉俊秀,原田信比古,高崎健.十二指腸温存膵頭全切除の適応と術式[J].消化器外科,2001,24(1):49-55.
[3]郭克建,田雨霖,董明.保留十二指肠的胰头切除术[J].中国实用外科杂志,1995,15(9):568-571.
[4]王磊,赵玉沛,陈革,等.保留十二指肠的胰头切除术[J].临床外科杂志,2004,12(4):215-216.
[5]Berger HG,Krautzberger W,Britter R,et al.Duodenum-preserving resection of the head of the pancreas with severe chronic pancreatitis[J].Surgery,1985,97(4):467-467.
[6]Imaizumi T,Hanyu F,Suzuki M,et al.Clinical experience with duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy[J].J Hepat-ol Bil Pancr Surg,1995,2(1):38-44.
[7]Takada T,Yasuda H,Uchiyama K.Complete duodenum preservingresection of the head of the pancreas with preservation of the biliary tract[J].J Hepatol Bil Pancr Surg,1995,2(1):32-37.
[8]韩永坚,刘牧之,主编.临床解剖学丛书(腹盆部分册)[M].北京:人民卫生出版社,1992:310.
[9]Kim SW,Kim KH,Jang JY,et al.Pratical guidelinesfor the preservationof the pancreaticoduodenal arteries during duodenumpreserving resection of the head ofthe p ancreas:clinical expe-rience and a study using resected specimens from pancreticoduodenect omy[J].Hepatogastroentereology,2001,48(37):264-269.
[10]Kimura W.Surgical anatomy of the pancreas for limited resection[J].J Hepatol Bil Pan cr Surg,2000,7(5):473-479.
[11]B Gloor,H Friess,M W Büchler.A modified technique of the Bergerand Frey procedure in patients with chronic pancreatitis[J].Dig Surg,2001,18(1):21-25.
[12]Grace PA,Pitt HA.Longmire WP.Pylorus preserving pancreatoduodenectomy:an overview[J].Br J Surg,1990,77(9):968-974.
[13]洪德飞,林志川,张宇华,等.保留十二指肠和胆管完整性胰头切除术31例报告[J].中华肝胆外科杂志,2017,23(3):176-180.
[14]洪德飞,张宇华,卢毅,等.腹腔镜保留十二指肠胰头切除术4例报告[J].中国实用外科杂志,2016,36(10):1081-1083.
[15]洪德飞.腹腔镜、机器人辅助行胰腺消化道重建策略及技术[J].中国实用外科杂志,2015,35(8):898-900.
[2]今泉俊秀,原田信比古,高崎健.十二指腸温存膵頭全切除の適応と術式[J].消化器外科,2001,24(1):49-55.
[3]郭克建,田雨霖,董明.保留十二指肠的胰头切除术[J].中国实用外科杂志,1995,15(9):568-571.
[4]王磊,赵玉沛,陈革,等.保留十二指肠的胰头切除术[J].临床外科杂志,2004,12(4):215-216.
[5]Berger HG,Krautzberger W,Britter R,et al.Duodenum-preserving resection of the head of the pancreas with severe chronic pancreatitis[J].Surgery,1985,97(4):467-467.
[6]Imaizumi T,Hanyu F,Suzuki M,et al.Clinical experience with duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy[J].J Hepat-ol Bil Pancr Surg,1995,2(1):38-44.
[7]Takada T,Yasuda H,Uchiyama K.Complete duodenum preservingresection of the head of the pancreas with preservation of the biliary tract[J].J Hepatol Bil Pancr Surg,1995,2(1):32-37.
[8]韩永坚,刘牧之,主编.临床解剖学丛书(腹盆部分册)[M].北京:人民卫生出版社,1992:310.
[9]Kim SW,Kim KH,Jang JY,et al.Pratical guidelinesfor the preservationof the pancreaticoduodenal arteries during duodenumpreserving resection of the head ofthe p ancreas:clinical expe-rience and a study using resected specimens from pancreticoduodenect omy[J].Hepatogastroentereology,2001,48(37):264-269.
[10]Kimura W.Surgical anatomy of the pancreas for limited resection[J].J Hepatol Bil Pan cr Surg,2000,7(5):473-479.
[11]B Gloor,H Friess,M W Büchler.A modified technique of the Bergerand Frey procedure in patients with chronic pancreatitis[J].Dig Surg,2001,18(1):21-25.
[12]Grace PA,Pitt HA.Longmire WP.Pylorus preserving pancreatoduodenectomy:an overview[J].Br J Surg,1990,77(9):968-974.
[13]洪德飞,林志川,张宇华,等.保留十二指肠和胆管完整性胰头切除术31例报告[J].中华肝胆外科杂志,2017,23(3):176-180.
[14]洪德飞,张宇华,卢毅,等.腹腔镜保留十二指肠胰头切除术4例报告[J].中国实用外科杂志,2016,36(10):1081-1083.
[15]洪德飞.腹腔镜、机器人辅助行胰腺消化道重建策略及技术[J].中国实用外科杂志,2015,35(8):898-900.