Whipple术治疗儿童壶腹周围肿瘤四例并文献复习  

Whipple's surgery for childhood periampullary neoplasms: a report of 4 cases and literature review

作　　者：乐盈 张明满[1] 李英存[1] 邓玉华[1] 熊强[1] Le Ying;Zhang Mingman;Li Yingcun;Deng Yuhua;Xiong Qiang(Department of Pediatric Surgery, Affiliated Children's Hospital, Chongqing Medical University, Ministry of Education Key Laboratory of Child Development & Disorders, China International Science & Technology Cooperation Base of Child Development & Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China)

机构地区：[1]重庆医科大学附属儿童医院肝胆外科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,400014

出　　处：《中华小儿外科杂志》2019年第9期811-816,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的总结Whipple术治疗儿童壶腹周围肿瘤的经验,并结合国内外相关文献对相关问题进行探讨。方法回顾性分析2016年1月至2017年12月重庆医科大学附属儿童医院收治的4例行Whipple术的患儿的临床资料。其中,男2例,女2例;年龄4~12岁,平均7岁。并通过PubMed、SpringerLink等英文数据库及中国知网(CNKI)、万方等中文数据库,对儿童Whipple术的中英文文献进行检索,系统性的总结。本次检索的关键词为胰十二指肠切除术、惠普尔氏术(pancreaticoduodenectomy、whipplesurgery、whippleprocedure)和儿童(children、child、pediatrics)。检索截止日期为2018年3月。并排除基础研究、无详细资料及同一作者、医院、数据库重复报道的病例。结果本组4例的手术时间为345~455min,平均402min;术中出血100~700ml,平均262.5ml。病理检查报告胰腺实性假乳头状瘤1例,胰母细胞瘤1例,胆管葡萄状胚胎性横纹肌肉瘤1例,B细胞淋巴母细胞瘤1例。4例患儿术后均恢复良好,随访期间无并发症。本文通过回顾中英文文献,共纳入有完整资料的患儿49例,包括英文文献14篇,中文文献2篇。结论Whipple术辅以化疗对儿童壶腹周围肿瘤治疗有效,预后良好,但应严格把握手术适应证,术中探查及冰冻对手术方式具有指导意义。Objective To explore the experience of Whipple's surgery in the treatment of periampullary neoplasms in children. Methods Clinical data were retrospectively analyzed for 4 children undergoing Whipple's surgery from January 2016 to December 2017. Systematic analysis and reviews of pediatric Whipple's surgery were performed for the Chinese and English literature retrieved from the databases of Pubmed, Medline, Springer Link, CNKI and Wanfang. Results There were 2 boys and 2 girls with an average age of 7(4-12) years. The average operative duration was 402 (345-455) min, the intraoperative blood loss 100-700 ml and the mean bleeding volume was 262.5 ml;The neoplastic histology were solid pancreatic pseudopapillary tumor, pancreatoblastoma, bile duct grapevine embryonal rhabdomyosarcoma and B-cell lymphoblastoma respectively. All cases had excellent outcomes without complications during follow-ups. Forty-nine children with complete data were reported in 14 English articles and 2 Chinese articles were retrieved. Conclusions Whipple's surgery plus chemotherapy are efficacious for periampullary neoplasms in children. Surgical indications should be strictly mastered. Intraoperative exploration and freeze biopsy are helpful for selecting surgical approaches.

关 键 词：胰十二指肠切除术 肿瘤 并发症 

分 类 号：R735.0[医药卫生—肿瘤]