胰十二指肠切除的术中探查与失误

PITFALLS OF INTRAOPERATIVE EXPLORATIONOF PANCREATI CODUODENECTOMY

本文总结了６０例Ｗｈｉｐｐｌｅ切除的术中诊断经验与教训。５２例确诊为Ｖａｔｅｒ壶腹周围恶性肿瘤。８例良性病变中有７例系术中探查的经验不足而误切。作者认为，须有确定的病理诊断才能决定Ｗｈｉｐｐｌｅ切除。文中提出了手术探查的步骤与方法。在可疑情况下，需切开胆总管和十二指肠行直视检查，以排除高位胆管癌、壶腹结石嵌顿、十二指肠穿透性溃疡及慢性胰腺炎等。

he article summarized the experience and pitfalls in decision making ofWhipple's resection in 60 cases. 52 patients were correctly diagnosed as malig-nant tumor of Vater's periampullary region,other 8 patients with benign lesionswere misdiagnosed as malignancy and unnecessarily operated on.The author considers that Whipple's resection can only be performed onthose patients who have definite histological diagnoses ,and some concrete proce-dures and measures of exploration should be closely followed. In suspicious cas-es, the common bile duct and duodenum should be incised and examined underdirect vision to exclude upper-cholangiocarcinoma , impacted stone in the ampullavater ,penetrating duodenal ulcer and chronic pancreatitis ,etc.