胰颈部肿瘤的胰十二指肠切除术

Pancreatoduodenectomy for tumors of the neck of the pancreas

目的:总结胰颈部肿瘤的临床特点并探讨选择性动静脉优先处理及全胰头血流阻断法在胰颈部肿瘤的胰十二指肠切除术(pancreatoduodenectomy,PD)中的应用.方法:回顾性分析我院2011-01/2013-06收治的25例胰颈部肿瘤行胰十二指肠切除术的患者的临床病理资料,针对每例患者的不同情况分别采用了选择性动静脉优先处理及全胰头血流阻断法.结果:本组患者中,25例患者均无黄疸,但均有不同程度的腰背部疼痛,其中21例为剧烈的腰背部疼痛,术中可见胰腺质地硬,胰管均扩张,并可见不同程度的炎症表现,肿瘤基本都累及静脉或者动脉;25例患者均行PD,全组无1例术中死亡,术中出血量600-900 mL,手术时间7-8 h,术后消化系出血2例,胃排空延迟4例,腹泻3例,均经保守治疗好转出院,术后腰背部疼痛完全缓解10例,明显缓解13例,部分缓解2例.结论:胰颈部肿瘤早期一般无特异症状,黄疸出现较晚,甚至至就诊时亦未出现,晚期均出现腰背部疼痛,基本都伴有远端胰管扩张,胰腺质地很硬,炎症较重,肿瘤边界不清,容易累及邻近的重要血管,手术难度大,采用选择性动静脉优先处理及全胰头血流阻断法能保障手术安全进行,减少术后并发症的发生.

AIM： To summarize the clinical features of tumors of the neck of the pancreas and investigate the application of selective arteriovenous priority processing and total pancreatic blood occlusion in pancreatoduodenectomy for tumors of the neck of the pancreas. METHODS： Clinical and pathological data for 25 patients with tumors of the neck of the pancreas who underwent pancreatoduodenectomy at our hospital from January 2011 to June 2013 were retrospectively analyzed. Selective arteriovenous priority processing and total pancreatic blood occlusion were performed depending on the patient’s features. RESULTS： This group of patients had no jaundice but suffered from back pain, and 21 of them had severe back pain. During the operation, hard pancreatic texture, dilatation of the pancreatic duct, and various degree of inflammation were visible. All the tumors invaded either arteries or veins. No morbidity was observed. The operative time was 7-8 h, and the blood loss was 600-900 mL. Among all the postoperative mortalities, there were 2 cases of gastrointestinal bleeding, 4 cases of delayed gastric emptying and 3 cases of diarrhea after, and all were treated by conservative management without reoperation. The symptoms of back pain was totally relieved in 10 cases, substantially relived in 13 and partially relieved in 2. CONCLUSION： Tumors of the neck of the pancreas have no specific symptoms in early stages. The symptom of jaundice appears late. In the late stages of the disease, back pain occurs in all cases, with the dilation of the distal pancreatic duct, a hard texture of the pancreas and severe inflammation. The tumor boundary is not clear, and there is a tendency to involve adjacent vessels. Selective arteriovenous priority processing and total pancreatic blood occlusion can guarantee the safety of the operation and reduce the incidence of postoperative complications.