保留十二指肠胰头全切除术11例临床分析  

Clinical effect of duodenum-preserving total pancreatic head resection in 11 cases

作　　者：孙浦 徐寅凯 何骏[1] 崔世鹏 赵华[1] SUN Pu;XU Yinkai;HE Jun;CUI Shipeng;ZHAO Hua(Department of General Surgery,the First Affiliated Hospital of Soochow University,Soochow,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院普外科,江苏苏州215000

出　　处：《肝胆胰外科杂志》2024年第2期75-80,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 探讨保留十二指肠胰头全切除术(DPPHRt)对胰头良性及低度恶性疾病的治疗经验,包括手术适应证、手术并发症尤其是胆管并发症的防治。方法 回顾性分析2021年7月至2023年5月苏州大学附属第一医院11例施行DPPHRt患者的病例资料。结果 本组共11例,其中男7例,女4例,平均年龄55.6岁,平均手术时间249(165~390)min,平均术中出血量187(50~500)mL,平均术后住院时间27.6(12~55)d。疾病类型:慢性肿块型胰腺炎2例(1例伴胰管结石),慢性胰腺炎1例(车祸外伤所致),胰腺神经内分泌肿瘤1例,胰头导管内乳头状瘤(IPMN)5例,胰腺浆液性囊腺瘤1例,胰头黏液性囊肿1例。手术方式均为开腹手术,无手术死亡。术后发生胰瘘3例(均为B级胰瘘),胆瘘3例,胆总管狭窄3例,腹腔出血1例,腹腔感染1例,胃排空延迟2例,经非手术治疗均治愈出院。术后获得随访11例,随访时间为2个月至2年,无复发、内外分泌功能减退、胃排空延迟等远期并发症发生,无死亡病例。结论 DPPHRt对胰头良性与低度恶性疾病是一种有效的手术方式。Objective To investigate the experience of treating benign and low-grade malignant diseases of the pancreatic head with duodenum-preserving total pancreatic head resection(DPPHRt),focusing on indications for surgery,complications,and particularly the prevention and treatment of biliary complications.Methods The clinical data of 11 patients who underwent DPPHRt at the First Affiliated Hospital of Soochow University from Jul.2021 to May 2023 were retrospectively analyzed.Results The study included 11 patients,comprising 7males and 4 females,with an average age of 55.6 years.The average duration of surgery was 249 min,ranging from 165 to 390 min.The average intraoperative blood loss was 187 mL,ranging from 50 to 500 mL.The average postoperative hospital stay was 27.6 d,ranging from 12 to 55 d.The types of disease included:2 cases of chronic mass-forming pancreatitis(1 with pancreatic duct stones),1 case of chronic pancreatitis due to a car accident,1 case of pancreatic neuroendocrine tumor,5 cases of intraductal papillary mucinous neoplasm(IPMN)of the pancreatic head,1 case of serous cystadenoma of the pancreas,and 1 case of mucinous cystic neoplasm of the pancreatic head.All surgeries were open procedures,with no operative deaths.Postoperative complications included 3 cases of pancreatic fistula(all grade B),3 cases of biliary fistula,3 cases of common bile duct stricture,1 case of abdominal hemorrhage,1 case of intra-abdominal infection,and 2 cases of delayed gastric emptying.All complications were successfully treated with non-surgical treatments.The follow-up of the 11 patients ranged from 2 months to 2 years,with no recurrence,endocrine or exocrine insufficiency,delayed gastric emptying,other long-term complications,or deaths.Conclusion DPPHRt is an effective surgical method for treating benign and low-grade malignant diseases of the pancreatic head.

关 键 词：保留十二指肠胰头全切除 胰十二指肠切除术 胆管并发症 胰头良性疾病 

分 类 号：R657.5[医药卫生—外科学]