全胰十二指肠切除术的安全性与疗效分析  

Clinical analysis of effect and safty of total pancreatectomy

作　　者：陶杰[1] 耿智敏[1] 王林[1] 石磊[1] 李文智[1] 姚春[1] 

机构地区：[1]西安交通大学医学院第一附属医院肝胆外科,陕西西安710061

出　　处：《西部医学》2015年第7期1011-1012,1015,共3页Medical Journal of West China

基　　金：陕西省科技攻关项目(2014K11-03-03-12)

摘　　要：目的探讨全胰十二指肠切除术治疗胰腺肿瘤和慢性胰腺炎的安全性和临床疗效。方法回顾性分析15例全胰十二指肠切除术患者的术后并发症发生情况、血糖控制情况、生活质量变化及术后生存率。结果本组患者中胰腺导管腺癌10例,胰腺神经内分泌癌1例,IPMN 2例,慢性胰腺炎2例（1例合并胰管结石）。其中手术联合门静脉切除重建4例,围手术期无死亡病例。术后并发症总发生率为26.7%（4/15）,其中胃排空障碍2例,肺部感染1例,切口感染1例,无胆瘘、腹腔出血等并发症发生。术后控制血糖每日胰岛素用量18~30U,效果理想,生活质量较术前有明显提高。11例患者获随访6~37个月,平均25.4个月,其中胰腺导管癌中位生存期为9个月（3~18个月）。结论全胰十二指肠切除术可以达到R0,围手术期管理的提高使近期疗效更理想,并发症无增加,血糖控制满意,同时可改善远期生活质量,因此对部分胰腺疾病行全胰十二指肠切除术不仅有效而且安全。Objective To evaluate the safety and efficacy of operation total pancreatectomy（TP）in treatment of pancreatic carcinoma and chronic pancreatitis.Methods The postoperative complications,blood sugar control,the changes of life quality and survival rate after operation of 15 patients with total pancreatectomy were analyzed.Results This group of patients include 10 cases of pancreatic ductal adenocarcinoma,1cases of pancreatic neuroendocrine carcinoma,2cases of IPMN and 2cases of chronic pancreatitis.The operation combined with portal vein resection and reconstruction in 4cases.There was no mortality.Postoperative complications rate was 26.7%（4/15）,including 2cases of gastric emptying,pulmonary infection in 1cases,incision infection in 1cases.No biliary fistula,abdominal bleeding complications.Quality of life was improved.The median survival period of the pancreatic duct cancer was 9 months（3 ~ 18months）.Conclusion TP can achieve an R0,Because of the improvement of perioperative management.The recent curative effect is ideal of TP,without increasing complications,satisfactory blood sugar control,and can improve the quality of life.

关 键 词：胰腺肿瘤 全胰十二指肠切除术 并发症 

分 类 号：R656[医药卫生—外科学]