中段胰腺切除术治疗胰腺体部肿瘤的初步经验  

Central pancreatectomy for neoplasms in the middle segmental pancreas

作　　者：万涛[1] 陈明易[1] 周晓东 张安红[1] 贾伟[1] 徐明月[1] 冯玉泉[1] 史宪杰[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853 [2]解放军第535医院外科,湖南怀化418000

出　　处：《中国现代医学杂志》2013年第14期63-66,共4页China Journal of Modern Medicine

摘　　要：目的探讨胰腺中段切除术在治疗胰腺体部肿瘤中的治疗价值。方法对该院2011年3月～2011年12月实施中段胰腺切除术的5例胰腺中段肿瘤患者的临床资料进行回顾性分析。结果 5例患者中术前诊断为无功能胰岛细胞瘤1例,胰腺实性假乳头样瘤3例,外伤性胰腺断裂伴胰腺假性囊肿1例,术后病理证实分别为胰腺实性假乳头样瘤(3例)、胰腺腺泡癌(1例)和胰腺真性囊肿(1例),其中4例采用经典的远端胰管空肠吻合术,留置胰管支撑管外引流,1例结扎远端胰管。5例患者均顺利恢复。结论胰腺中段肿瘤容易误诊,常规行胰腺B超和CT检查是早期发现该病的有效方法,为避免误诊应积极手术切除。有选择性地采用中段胰腺切除术可获得满意疗效,同时最大限度地保留胰腺内外分泌功能。【Objective】 To review the experience of central pancreatectomy procedure in treating neoplasms in the middle segmental pancreas.【Methods】 Five cases of pancreatic neoplasm admitted into our hospital from January 2011 to December 2011 were analyzed retrospectively.Of the 5 patients in this group,the pathological diagnosis was nonfunctioning islet cell carcinoma,solid pseudopapillary tumor（3 cases） and pancreatic true cyst respectively,three cases were misdiagnosed preoperatively.All patients were undergone central pancreatectomy,including the body and part of tail of the pancreas,and 4 cases were treated with Roux-en-Y end-to-side pancreaticojejunostomy using the duct-to-mucosa method and exo-drainage of the pancreatic cyst.【Results】 Median operative time was 270 min.Perioperative mortality was nil.Complication after operation was pancreatic fistula（2 cases）.No patients required postsurgical reoperation.No one patient had clinical exocrine insufficiency.None developed postresection new-onset insulin-dependent diabetes.【Conclusions】To be of vigilance for the tumors of pancreas,ultrasonography and CT are the most effective method to find the early tumor of the pancreatic body,less misdiagnosis occurrence and active radical surgical resection must be done and may get longer survival.Middle pancreatectomy is feasible and reasonable technique.Although the incidence of pancreatic fistula formation may still be higher compared to conventional resection,long-term exocrine,and endocrine pancreatic function may be preserved.Thus,it is necessary to be performed in selected patients by experienced pancreatic surgeons.

关 键 词：胰腺肿瘤 中段胰腺切除 外科治疗 

分 类 号：R735.9[医药卫生—肿瘤]