脏器保留原则下胰腺良性肿瘤的外科治疗

Surgical Treatment of Pancreatic Benign Tumors Following Organ Preserving Principle

目的:讨论胰腺良性肿瘤的脏器保留原则指导下外科治疗价值。方法:对45例胰腺良性肿瘤分别行脏器保留原则指导下手术治疗,其中术式包括肿物摘除术、胰腺节段性切除术、胰体尾加脾切除、保留脾脏胰体尾切除及胰十二指肠切除术后临床经过和胰瘘的发生率加以分析。结果:胰漏发生率分别为55%(11/20),33.3%(3/9),25%(1/4),0(0/6),33.3%(2/6)。胰瘘发生率30.8%(17/45),脏器保留原则指导手术未增加胰瘘发生率(P=0.449)并且与传统手术组相比术后未增加糖尿病发生率(P=0.515)。结论:脏器保留原则指导下手术胰腺切除是一种安全、有效的手术方式,生长抑素不能预防胰瘘的发生,但是可以缩短胰瘘闭合的时间。

Objective Disscusion the value of surgical treatment of the benign pancreatic tumor following the organ preserving principle. Methods The clinical outcome and pancreatic leakage of forty-five patients with benign lesions of the pancreas treated with evacuation, pancreatic segmental resection, pancreatic body and tail with spleen resection, pancreatic body and tail resection without spleenectomy and whipple＇ s procedure were retrospectively analyzed in our hospital during the past ten years. Results Pancreatic leakage rate were 55% （11/20）, 33.3% （3/9）, 25% （1/4）, 0（0/6）, 33.3% （2/6）and no pancreatic leak was found in 6 patients with distal pancreatectomy without splenectomy. The rate of pancreatic leak is 30.8%. Pancreatic resections following organ preserving principle do not increase the pancreatic leakage（P=0.449）and didn＇t increase the diabetes in- cidence post the surgery （P=0.515）. Conclusion Pancreatic resections following organ preserving principle are safe, effective treatment to pancreatic benign tumors, somatostatin analogue can not prevent the patients from pancreatic leak, but can shorten the healing time.