中段胰腺切除术19例临床分析  

Clinical analysis of central pancreatectomy in 19 cases

作　　者：杨正江 付晓伟 孙根 辛万鹏 易思清 姜海 李勇[1] 肖卫东[1] YANG Zhengjiang;FU Xiaowei;SUN Gen;XINWanpeng;YI Siqing;JIANG Hai;LI Yong;XIAO Weidong(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院普通外科,江西南昌330006

出　　处：《中国普通外科杂志》2022年第3期304-309,共6页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81860418);江西省重点研发计划资助项目(20192BBG70035);江西省自然科学基金资助项目(20202ACB206007);南昌大学研究生创新专项资金资助项目(CX2019160)。

摘　　要：背景与目的:胰十二指肠切除术(PD)和胰体尾切除术(DP)被认为是治疗胰腺肿瘤的标准术式。然而,它们应用于治疗良性或低度恶性肿瘤时可能导致的胰腺内外分泌功能不足需引起重视。本研究旨在探讨中段胰腺切除术(CP)治疗胰颈部或近端体部良性或低度恶性肿瘤的临床疗效。方法:回顾性分析南昌大学第一附属医院2009年6月—2020年8月间19例施行CP术患者的临床资料,其中胰腺实性假乳头状瘤8例,浆液性囊腺瘤4例,神经内分泌肿瘤4例,假性囊肿、副神经节瘤、炎性肉芽肿各1例。结果:15例行开腹手术,4例行微创手术;远端胰腺消化道重建方式包括胰管空肠黏膜吻合15例,胰胃吻合4例。平均手术时间为(224.0±40.4)min,平均术中出血量(173.2±50.9)m L。总体并发症和临床相关胰瘘发生率分别为52.6%和26.3%。平均术后住院时间(11.8±6.5)d。无再次手术及手术相关死亡。平均随访时间(59.3±39.0)个月,无1例发生胰腺内外分泌功能不足,无肿瘤复发。结论:CP术治疗胰颈部或近端体部良性或低度恶性肿瘤能最大限度保留胰腺内外分泌功能,但伴随相对较高的胰瘘发生率。Background and Aims:Pancreaticoduodenectomy(PD)and distal pancreatectomy(DP)are considered as the standard procedures for pancreatic tumors.However,it needs to be noted that the endocrine and exocrine pancreatic insufficiency may occur after performing these tow procedures for benign or lowgrade malignant tumors.The aim of this study was to investigate the clinical efficacy of central pancreatectomy(CP)for benign or low-grade malignant tumors in the neck and proximal body of the pancreas.Methods:The clinical data of 19 patients who underwent CP from June 2009 to August 2020 in the First Affiliated Hospital of Nanchang University were retrospectively analyzed.Among the patients,there were solid pseudopapillary tumor in 8 cases,serous cystadenoma in 4 cases,neuroendocrine tumor in4 cases,and pseudocyst,paraganglioma and inflammatory granuloma in one case each.Results:Fifteen patients underwent open surgery and 4 patients had minimally invasive surgery.The reconstruction methods of the distal pancreatic remnant included duct-to-mucosa pancreaticojejunostomy in 15 cases and pancreaticogastrostomy in 4 cases.The mean operative time was(224.0±40.4)min,and the mean intraoperative blood loss was(173.2±50.9)m L.The incidence rates of overall complications and clinically relevant postoperative pancreatic fistula were 52.6%and 26.3%,respectively.The mean postoperative hospital stay was(11.8±6.5)d.No reoperation and surgery-related death occurred.The mean follow-up time was(59.3±39.0)months,and endocrine or exocrine pancreatic insufficiency occurred in none of them as well as no tumor recurrence was noted.Conclusion:CP for the treatment of benign or low-grade malignant lesions in the neck or proximal body of the pancreas can maximally preserve the endocrine and exocrine pancreatic function,but it is associated with a relative high incidence of pancreatic fistula.

关 键 词：胰腺切除术 胰腺肿瘤 胰腺瘘 

分 类 号：R657.5[医药卫生—外科学]