四种保留器官的胰腺切除术式的指征、技术和疗效

Indications, techuique and efficacy of organ preserving pancreatectomy

目的 探索四种保留器官的胰腺切除术式在治疗胰腺良性及低度恶性肿瘤中的疗效.方法 回顾性总结1990年1月至2010年5月施行的72例保留器官胰腺切除术的手术经验及疗效,男性24例,女性48例,年龄15～68岁,平均46岁.其中行保留十二指肠的胰头切除术（DPRHP）9例,行保留脾脏的胰体尾切除术（SPDP）29例,行胰腺中段切除术11例,行胰腺头体部巨大肿瘤摘除术23例.结果 行DPRHP的9例患者中,术后并发胰瘘、胆瘘各1例,均经保守治疗愈合.行SPDP的29例患者中,术后并发胰瘘3例,未发生迟发性脾梗死.行胰腺中段切除的11例患者中,术后合并胰肠吻合口出血1例,经手术治疗治愈.行胰腺头体部巨大肿瘤摘除术的15例非功能性胰岛细胞瘤患者中,术后并发胰瘘5例,3例于术后6、12、16个月出现肝转移;行肿瘤摘除术的8例黏液性囊腺瘤患者中,术后并发胰瘘2例.结论 保留器官的胰腺切除术可明显减轻手术创伤,疗效与传统术式相同,应作为胰腺良性或低度恶性肿瘤的首选术式.

Objective To discuss the proper surgical management of pancreatic benign and lowgrade malignant potential neoplasm. Methods The experience of 72 cases who accepted organ preserving pancreatectomy from January 1990 to May 2010 was analyzed retrospectively. There were 24 male and 48 female,aged from 15 to 68 years with mean age of 46 years. There were 9 cases underwent duodenumpreserving resection of the head of the pancreas ,29 cases underwent spleen-preserving distal pancreatectomy,11 cases underwent middle segmental pancreatectomy, 23 cases underwent tumor extirpation of huge pancreatic cancer in pancreatic head and body. Results Pancreatic fistula and biliary fistula in 1 case respectively were cured among who accepted duodenum-preserving resection of the head of the pancreas.Pancreatic fistula was found in 3 cases who accepted spleen-preserving distal pancreatectomy.Pancreaticobiliary anastomotic bleeding in 1 case was cured among who accepted middle segmental pancreatectomy. Pancreatic fistula was found in 5 cases among who accepted tumor extirpation of huge pancreatic cancer in pancreatic head and body, and liver metastasis was found in 3 cases at 6,12,16 months after surgery respectively. Conclusions Organ preserving pancreatectomy can obviously reduce operative injury to patients, its therapeutic effect is similar to that of classical operation, it is the first option of benign and low-grade malignant potential neoplasm.