中段胰腺切除术(附10例报告)

Medial pancreatectomy:a report of 10 cases

目的探讨中段胰腺切除术的临床应用价值。方法回顾性分析1990年1月至2003年10月间10例中段胰腺切除术病人的临床资料,男6例,女4例,平均年龄46.6岁。本组病例中病理诊断胰腺内分泌肿瘤5例,胰腺囊腺瘤4例,慢性胰腺炎伴胰石症1例。2例行中段胰腺切除+胰头空肠、胰体空肠、空肠空肠吻合术,8例行中段胰腺切除+胰体空肠 Roux-en-Y 吻合术。结果术后均无死亡。术后发生胰瘘2例,经保守治疗2个月和2周后均痊愈。仅1例无功能性胰岛细胞瘤的病人术后出现血糖轻度增高,随访1年血糖无变化。10例病人中8例随访至2004年4月均健在,无复发。结论中段胰腺切除术适用于位于胃十二指肠动脉左侧和近脾静脉与肠系膜下静脉汇合处之间良性或低度恶性的胰腺肿瘤。该术式有利于降低胰腺术后糖尿病的发生和维持胃肠道的功能。

Objective To determine the clinical value of medial pancreatectomy. Methods The clinical data of 10 patients receiving medial pancreatectomy in our hospital from January 1990 to December 2003 were retrospectively analyzed. Of the 10 patients with a median age of 46.6 years old, 6 were male and 4 female. Pathologically, it was endocrine neoplasm in 5 patients, cystic adenoma in 4 and chronic pancreatitis accompanied by pancreatic lithiasis in 1. The surgical procedures were medial pancreatectomy with omega-shaped pancreaticojejunostomy in 2 patients and medial pancreatectomy with Roux-en-Y pancreaticojejunostomy in 8. Results No in-hospital death occurred. Pancreatic fistula occurred in 2 patients （20%） after the operation. Only 1 patient with nonfunctional endocrine tumor presented with the slightly elevation of blood sugar postoperatively. The follow-up in 8 patients showed good outcome and no recurrence. Conclusions Medial pancreatectomy is appropriate for the benign or low-grade malignant tumors in the midportion of the pancreas which is located between the left side of gastroduodenal artery and splenomesenteric confluence. Medial pancreatectomy with Roux- en-Y pancreaticojejunostomy might be the better choice to decrease the risk of pancreatic fistula. Meanwhile, medial pancreatectomy is a conservative operation for maintaining the endocrine and exocrine functions of the oancreas.