胰头占位伴致密钙化的手术切除
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摘要
目的评估保留十二指肠的胰头切除治疗胰头致密钙化占位的预后,总结手术要点。方法回顾性分析四川大学华西医院胰腺外科于2016年5月收治的1例罕见的胰头占位伴致密钙化的中年女性患者的临床资料。结果患者行保留十二指肠的胰头切除,手术顺利完成,手术时间207 min,术中出血量约为130 mL,术后住院时间为12 d。患者于术后3 d拔除胃管并下床活动;术后每日腹腔引流量约为30 mL,至术后7 d引流量减至10 mL,拔除腹腔引流管。术后每2天复查血清学淀粉酶及体液淀粉酶浓度,指标均正常。患者术后未诉特殊不适,术后无明显胰瘘、十二指肠瘘、胆汁漏、胃排空延迟、腹腔积液、胸腔积液、腹腔感染及腹腔出血发生。术后随访18个月,预后良好,无复发征象,无特殊不适。结论针对罕见的胰头占位伴致密钙化,行保留十二指肠的胰头切除可取得较好的预后。
Objective To estimate the prognosis of duodenum-preserving resection of pancreatic head(DPRPH)in the treatment of space occupying with extensive calcification of pancreatic head, and to summarize the key points of surgery. Methods The clinical data of a middle-aged woman with rare space occupying with extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed. Results The DPRPH operation was successfully completed, with the operative time was 207 min,the intraoperative blood loss was 130 mL, and the hospital stay was 12 d. Removing time of the gastric tube and off-bed activity were on the 3rd day after operation, and the volume of peritoneal drainage per day was decreasing from 30 mL to10 mL until 7th day after operation. We made examination of serum amylase and fluid amylase for the patient every 2 days,and the examination indexes were within normal level. After removing the peritoneal drainage tube, the pain was obviously relieved on the 12 th day after operation, then the patient made hospital discharge. There was no observable pancreatic fistula, duodenal fistula, biliary fistula, delay gastric emptying, peritoneal effusion, pleural effusion, abdominal infection, and abdominal bleeding, neither nor any special discomfort. During the follow-up period of 18 months, we got a good prognosis without any symptom of relapse or discomfort according to the result of CT scans and other examinations.Conclusion DPRPH can make a satisfied prognosis in the treatment of rare space occupying with extensive calcification of pancreatic head.
Objective To estimate the prognosis of duodenum-preserving resection of pancreatic head(DPRPH)in the treatment of space occupying with extensive calcification of pancreatic head, and to summarize the key points of surgery. Methods The clinical data of a middle-aged woman with rare space occupying with extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed. Results The DPRPH operation was successfully completed, with the operative time was 207 min,the intraoperative blood loss was 130 mL, and the hospital stay was 12 d. Removing time of the gastric tube and off-bed activity were on the 3rd day after operation, and the volume of peritoneal drainage per day was decreasing from 30 mL to10 mL until 7th day after operation. We made examination of serum amylase and fluid amylase for the patient every 2 days,and the examination indexes were within normal level. After removing the peritoneal drainage tube, the pain was obviously relieved on the 12 th day after operation, then the patient made hospital discharge. There was no observable pancreatic fistula, duodenal fistula, biliary fistula, delay gastric emptying, peritoneal effusion, pleural effusion, abdominal infection, and abdominal bleeding, neither nor any special discomfort. During the follow-up period of 18 months, we got a good prognosis without any symptom of relapse or discomfort according to the result of CT scans and other examinations.Conclusion DPRPH can make a satisfied prognosis in the treatment of rare space occupying with extensive calcification of pancreatic head.
引文
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2Smits FJ, van Santvoort HC, Besselink MG, et al. Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg, 2017, 152(6):540-548.
3El Nakeeb A, Salem A, Mahdy Y, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy:a case-control study. Asian J Surg, 2018, 41(2):155-162.
4Beger HG, Witte C, Meves M, et al. Experiences in organpreserving surgical methods in the treatment of gastroduodenal ulcers. Results after vagotomy and pyloroplasty. Chirurg, 1972,43(3):127-131.
5Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6):701-707.
6Büchler MW, Bassi C, Fingerhut A, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Ann Surg, 2001,234(2):262-263.
7Nassani N, Tong GX, Zheng X, et al. Pancreatic head cystic lesion resembling a pancreatic cystic neoplasm corresponding to a tonsillar squamous cell carcinoma metastasis to the pancreas. Am J Gastroenterol, 2017, 112(S1):S695.
8Sethi S, Puri SK, Agarwal A. Primary pancreatic hydatid:a rare cystic lesion of the pancreas. Am J Trop Med Hyg, 2017, 96(4):763-764.
9Goh BKP, Kwek ABE, Wan WK. An unusual cause of a solid-cystic pancreatic lesion. Gastroenterology, 2018, 154(4):e4-e5.
10Schneider M, Lesurtel M, Weber A. Pancreatic cystic lesion with baffling fluid levels of CEA and amylase. J Gastrointestin Liver Dis,2016, 25(3):270.
11Choi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas:typical and atypical manifestations. AJR Am J Roentgenol, 2006, 187(2):W178-W186.
12Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis:the multicentre, randomised,controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099):1027-1037.
13Niesen W, Hank T, Angelova Y, et al. Patient-reported long-term outcomes after duodenum-preserving pancreatic head resection(berne modification)for chronic pancreatitis. Pancreatology, 2017,17 (3):S88-S89.
14Beger HG, Mayer B. Duodenum-preserving pancreatic head resection in chronic pancreatitis:limitations of the Heidelberg multicenter ChroPac study. Chirurg, 2018, 89(5):392-396.
15Kemper M, Izbicki JR, Bachmann K. Surgical treatment of chronic pancreatitis:the state of the art. Chirurgia(Bucur), 2018, 113(3):300-306.
16Milanetto AC, Li?o V, Alaggio R, et al. Duodenum preserving pancreatic head resection for treatment of neuroendocrine pancreatic tumors of the head of the pancreas. Pancreatology, 2016,16 (3):S65-S66.
17Beger HG. Benign tumors of the pancreas-radical surgery versus parenchyma-sparing local resection-the challenge facing surgeons.J Gastrointest Surg, 2018, 22(3):562-566.
18Gurusamy KS, Lusuku C, Halkias C, et al. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database Syst Rev, 2016, 2:CD011521.
19Chen J, Jiang K, Wu J, et al. Application of intraoperative transluminal core-biopsy for diagnosis of pancreatic head mass:a single center 15-year experience. Pancreatology, 2018, 18(1):68-72.
20Radenkovic D, Farnell MB, Bassi C, et al. Evolving techniques in pancreatic surgery. Gastroenterol Res Pract, 2016, 2016:4289724.
2Smits FJ, van Santvoort HC, Besselink MG, et al. Management of severe pancreatic fistula after pancreatoduodenectomy. JAMA Surg, 2017, 152(6):540-548.
3El Nakeeb A, Salem A, Mahdy Y, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy:a case-control study. Asian J Surg, 2018, 41(2):155-162.
4Beger HG, Witte C, Meves M, et al. Experiences in organpreserving surgical methods in the treatment of gastroduodenal ulcers. Results after vagotomy and pyloroplasty. Chirurg, 1972,43(3):127-131.
5Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6):701-707.
6Büchler MW, Bassi C, Fingerhut A, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Ann Surg, 2001,234(2):262-263.
7Nassani N, Tong GX, Zheng X, et al. Pancreatic head cystic lesion resembling a pancreatic cystic neoplasm corresponding to a tonsillar squamous cell carcinoma metastasis to the pancreas. Am J Gastroenterol, 2017, 112(S1):S695.
8Sethi S, Puri SK, Agarwal A. Primary pancreatic hydatid:a rare cystic lesion of the pancreas. Am J Trop Med Hyg, 2017, 96(4):763-764.
9Goh BKP, Kwek ABE, Wan WK. An unusual cause of a solid-cystic pancreatic lesion. Gastroenterology, 2018, 154(4):e4-e5.
10Schneider M, Lesurtel M, Weber A. Pancreatic cystic lesion with baffling fluid levels of CEA and amylase. J Gastrointestin Liver Dis,2016, 25(3):270.
11Choi JY, Kim MJ, Kim JH, et al. Solid pseudopapillary tumor of the pancreas:typical and atypical manifestations. AJR Am J Roentgenol, 2006, 187(2):W178-W186.
12Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis:the multicentre, randomised,controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099):1027-1037.
13Niesen W, Hank T, Angelova Y, et al. Patient-reported long-term outcomes after duodenum-preserving pancreatic head resection(berne modification)for chronic pancreatitis. Pancreatology, 2017,17 (3):S88-S89.
14Beger HG, Mayer B. Duodenum-preserving pancreatic head resection in chronic pancreatitis:limitations of the Heidelberg multicenter ChroPac study. Chirurg, 2018, 89(5):392-396.
15Kemper M, Izbicki JR, Bachmann K. Surgical treatment of chronic pancreatitis:the state of the art. Chirurgia(Bucur), 2018, 113(3):300-306.
16Milanetto AC, Li?o V, Alaggio R, et al. Duodenum preserving pancreatic head resection for treatment of neuroendocrine pancreatic tumors of the head of the pancreas. Pancreatology, 2016,16 (3):S65-S66.
17Beger HG. Benign tumors of the pancreas-radical surgery versus parenchyma-sparing local resection-the challenge facing surgeons.J Gastrointest Surg, 2018, 22(3):562-566.
18Gurusamy KS, Lusuku C, Halkias C, et al. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis. Cochrane Database Syst Rev, 2016, 2:CD011521.
19Chen J, Jiang K, Wu J, et al. Application of intraoperative transluminal core-biopsy for diagnosis of pancreatic head mass:a single center 15-year experience. Pancreatology, 2018, 18(1):68-72.
20Radenkovic D, Farnell MB, Bassi C, et al. Evolving techniques in pancreatic surgery. Gastroenterol Res Pract, 2016, 2016:4289724.