保留腹胰的背胰头部切除手术

Ventral pancreas-preserving resection of dorsal segment of the pancreatic head

胚胎解剖学:从胚胎发育角度看,原始背胰胚芽发育为除腹胰之外的其余胰腺,包括胰头、胰体及胰尾部,其中来源于背胰的胰腺头部称为背胰头部.适应证:1.背胰头部的良性或低度恶性肿瘤性病变,如囊腺瘤、IPMN、神经内分泌肿瘤等.2.胰腺分裂症.禁忌证:胰头癌.术式评价:1.该手术仅仅切除部分胰头组织,能够完整保留胆管、胆胰壶腹部、十二指肠等重要结构,因而能够充分保护器官功能、维持消化道的完整性.2.由于胰腺背侧不在手术范围之内,因此胰十二指肠后血管弓能够保持完整状态,十二指肠、胆管胰腺段及壶腹部能够保持良好的血液供应,无缺血之虑.3.手术相对简单:术中无需特别解剖胆管及壶腹部,保留的腹胰部分无需做胰肠吻合,腹胰断面的主胰管残端只需结扎即可.4.术后胰瘘发生率较高.

Embryonic anatomy:The embryonic bud of the original dorsal pancreas developed into the pancreas except the ventral pancreas according to embryonic development,including the head,body and tail of the pancreas.The pancreatic head from the dorsal segment was called the dorsal segment of the pancreatic head.Indications:1.Benign or low-grade malignant neoplastic lesions of the head of the pancreas,such as cystadenoma,IPMN,neuroendocrine tumor,etc.2.Pancreatic schizophrenia.Contraindications:pancreatic carcinoma.Evaluation of this operation:1.Only part of pancreatic head tissue is removed in this operation;and important structures such as bile duct,abdomen of biliopancreatic ampulla and duodenum can be completely preserved.Thus,organ functions and the integrity of digestive tract could be well preserved and maintained.2.The posterior pancreaticoduodenal vascular arch can be maintained intact;and the duodenum,bile duct and the ampulla can maintain good blood supply without the concern of ischemia.3.The operation is simple.No dissection of the bile duct and ampulla was required during the operation;no pancreaticoenterostomy was required for the reserved ventral pancreas.4.The incidence of postoperative pancreatic fistula is high.