术前置入胰管支架在邻近主胰管的胰腺肿瘤剜除术中的应用分析  

Effect of preoperative pancreatic duct stent placement in enucleation of pancreatic tumor adjacent to the main pancreatic duct

作　　者：于灏天 张树彬[1] 刘建华[1] 秦建章[1] 杜成旭 杨昕达 赵伟红[1] 吕海涛[1] Yu Haotian;Zhang Shubin;Liu Jianhua;Qin Jianzhang;Du Chengxu;Yang Xinda;Zhao Weihong;Lyu Haitao(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000

出　　处：《中华肝胆外科杂志》2025年第1期43-48,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的:探讨术前置入胰管支架在邻近主胰管的胰腺肿瘤剜除术中的应用效果。方法:回顾性分析2022年1月至2024年9月在河北医科大学第二医院肝胆外科行胰腺肿瘤剜除术的56例邻近主胰管的胰腺良性或交界性肿瘤患者的临床资料,其中男性25例,女性31例,年龄(32.0±5.5)岁。56例患者中胰腺实性假乳头状瘤患者35例(62.5%)、胰腺神经内分泌肿瘤15例(26.8%)、胰腺浆液性囊性瘤6例(10.7%)。根据胰腺肿瘤剜除术术前是否经内镜逆行胆胰管成像(ERCP)置入胰管支架分为两组:胰腺肿瘤剜除术联合术前ERCP置入胰管支架的20例患者纳入观察组,未置入胰管支架直接行胰腺肿瘤剜除术的36例患者纳入对照组。比较两组手术时间、术中胰管损伤情况、肿瘤剜除时间和出血量、B/C级胰瘘以及术后住院时间等。结果:所有患者均顺利完成胰腺肿瘤剜除术。观察组手术时间短于对照组[150.0(143.5,159.0)min比158.0(150.0,180.0)min, Z=-2.08, P=0.031],术中主胰管损伤率低于对照组[10.0%(2/20)比38.9%(14/36), χ^(2)=5.26, P=0.022],差异均有统计学意义。对比两组的肿瘤剜除时间与出血量,差异均无统计学意义(均 P>0.05)。观察组术后B/C级胰瘘发生率低于对照组[15.0%(3/20)比41.7%(15/36), χ^(2)=4.19, P=0.041],术后住院时间短于对照组[(7.9±1.6)d比(9.3±2.1)d, t=-2.57, P=0.014],差异均有统计学意义。 结论:邻近主胰管的胰腺肿瘤剜除术前经ERCP置入胰管支架可在保证手术相对安全的前提下,在术中保护主胰管,减少术后B/C级胰瘘的发生,缩短术后住院时间。ObjectiveTo study the effect of preoperative pancreatic duct stent placement in enucleation(EN)of pancreatic tumor adjacent to the main pancreatic duct(MPD).MethodsClinical data of 56 patients with benign or borderline pancreatic tumor adjacent to the MPD undergoing EN in the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2022 to September 2024 were retrospectively analyzed,including 25 males and 31 females,aged(32.0±5.5)years.Among the patients,35(62.5%)were solid pseudopapillary neoplasm,15(26.8%)were neuroendocrine tumor,and 6(10.7%)were serous cystic tumor.According to whether the pancreatic duct stent was placed through encoscopic retrograde cholangiopancreatography preoperatively,patients were divided into the stent group(n=20,observation group)and no-stent group(n=36,control group).The operation time,intraoperative pancreatic duct injury,tumor enucleation time and blood loss,grade B/C pancreatic fistula and postoperative hospital stay were compared between the two groups.ResultsAll patients underwent EN successfully.The operation time in the observation group was shorter than that in the control group[150.0(143.5,159.0)vs 158.0(150.0,180.0)min,Z=-2.08,P=0.031],and the rate of intraoperative MPD injury in the observation group was lower than that in the control group[10.0%(2/20)vs 38.9%(14/36),χ^(2)=5.26,P=0.022].The tumor enucleation time and blood loss were comparable between the two groups(both P>0.05).The rate of postoperative grade B/C pancreatic fistula in the observation group was lower than that in the control group[15.0%(3/20)vs 41.7%(15/36),χ^(2)=4.19,P=0.041],and the postoperative hospital stay was also shorter in the observation group[(7.9±1.6)vs(9.3±2.1)d,t=-2.57,P=0.014].ConclusionUnder the premise of matured endoscopic operation,preoperative pancreatic duct stent placement through ERCP in the EN of pancreatic tumor adjacent to the MPD can protect the MPD during operation,reduce the occurrence of postoperative grade B/C pancreatic fistu

关 键 词：胰腺肿瘤 胰腺肿瘤剜除术 主胰管 胰管支架 胰瘘 

分 类 号：R73[医药卫生—肿瘤]