保留十二指肠和胆管完整性胰头切除术31例报告  

Total pancreatic head resection with duodenum and bile duct preserving： a report of 31 patients

作　　者：洪德飞[1] 林志川[2] 张宇华[1] 陈宇峰[2] 沈国樑[1] 成剑[1] 卢毅[1] 张军港[1] 

机构地区：[1]浙江省人民医院肝胆胰外科及微创外科,杭州310014 [2]福建医科大学附属漳州市医院肝胆外科

出　　处：《中华肝胆外科杂志》2017年第3期176-180,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省科技厅重大专项（2013C03046）;浙江省卫计委重点学科重点项目（2015ZDA004）;浙江省自然科学基金（LY15H160054）

摘　　要：目的 总结保留十二指肠和胆管完整性胰头切除术的经验.方法 回顾性分析2012年4月至2016年5月浙江省人民医院肝胆胰外科和福建医科大学附属漳州市医院肝胆外科保留十二指肠和胆管完整性胰头切除术31例的临床资料.结果 本组31例患者均完成手术,其中腹腔镜手术4例,开腹手术27例.开腹组27例中,1例中转胰十二指肠切除术.患者平均手术时间（165.3±63.6） min,平均术中出血（258.1±156.9） ml.患者术后并发腹腔出血致再次手术1例.胆漏1例、A级胰漏13例（48.2％）,均保守治疗治愈.术后住院时间（11.7±6.3）d.腹腔镜组4例,平均手术时间350.0（280.0 ～450.0）min,平均术中出血425.0 ml（250.0 ～ 600.0） ml,术后并发A级胰漏3例,均保守治疗治愈,无其他并发症.术后平均住院时间14 d.术后病理：胰头部结石12例,胰头部浆液性囊腺瘤8例,导管内分支型乳头状粘液瘤4例,神经内分泌肿瘤5例,黏液性囊腺瘤2例.随访1 ～48个月,无糖尿病和脂肪泄等并发症发生.结论 保留十二指肠和胆管完整性胰头切除术治疗胰头部良性或低度恶性病变安全、有效、微创,符合脏器功能保护理念,值得临床推广应用.Objective To investigates the role of duodenum and bile duct preserving pancreatic head resection （DBPPHR） in treatment of benign or low-grade malignant diseases located in the head of pancreas.Methods The clinical data of 31 patients who underwent DBPPHR between April 2012 to May 2016 in Zhejiang Provincial People＇s Hospital and Zhangzhou Municipal Hospital of Fujian Province were analyzed retrospectively.Results Of the 31 patients,4 patients underwent laparoscopic DBPPHR.One patient in the open group was converted to pancreaticoduodenectomy.For the open group,the mean operation time was （165.3 ±63.6） min;the mean estimated blood loss was （258.1 ± 156.9） ml;and the mean postoperative stay was （11.7 ± 6.3） days.The postoperative complications included 1 reoperation due to postoperative bleeding,1 bile leakage and 13 patients developed grade A pancreatic fistula （48.2%）.For the laparoscopic group,the mean operation time was 350.0 （280.0 ～ 450.0） min;the mean estimated blood loss was 425.0 （250.0 ～600.0） ml;and the mean postoperative stay was 14 days.Three patients developed postoperative pancreatic fistula （grade A）.The pathological diagnosis were：12 patients with pancreatolithiasis,8 patients with serous cystadenoma,4 patients with branched intraductal papillary mucinous neoplasm,5 patients with neuroendocrine tumor and 2 patients with mucinous cystadenoma.The follow-up period was 1 ～ 48 month,and there was no patient with diabetes or diarrhea.Conclusions DBPPHR was safe and efficacious.It is less invasive to treat benign or low-grade malignant diseases located in the head of pancreas.

关 键 词：胰管结石 囊实性病变 胰腺 慢性胰腺炎 保留十二指肠胰头切除 腹腔镜手术 

分 类 号：R657.5[医药卫生—外科学]