胰十二指肠切除术

Pancreaticoduodenectomy

胰十二指肠切除术主要用于治疗壶腹周围肿瘤,标准的切除范围包括胰头及钩突、十二指肠、胆总管、胆囊、远端胃及近端空肠,还需常规行胰头周围淋巴结清扫（包括第6、8、12、13、14、17组淋巴结）,消化道重建包括胰空肠、胆管空肠及胃空肠吻合。该手术创伤大,术后并发症发生率较高达20%-40%。手术要点包括完整的胰腺钩突切除、规范的淋巴结清扫及满意的胰腺空肠吻合。本例患者为60岁女性,术前诊断为梗阻性黄疸、胆总管癌。行标准的胰十二指肠切除术,消化道重建采用Child顺序,胰腺空肠套入式吻合。手术用时4.3 h,出血约200 ml,未输血。术后患者恢复顺利,无并发症,术后2周出院。术后病理为胆总管下段中分化腺癌,淋巴结共22枚均无转移。

Pancreaticoduodenectomy （ Whipple ＇s procedure ） is mainly used for treatment of periampullary tumors. The classical extent of resection includes the pancreatic head, uncinate process, duodenum, common bile duct, gallbladder, distal stomach, and proximal jejunum, with a regular clearance of the lymph nodes around the head of pancreas （including group 6, 8, 12, 13, 14, and 17）.The reconstructions of the digestive tract include pancreatic-jejunumanastomosis, cholangio-jejunostomy and gastro-jejunostomy. The postoperative complication rate is still as high as 20%-40%.The key points of this procedure include the complete resection of the uncinate process, standardized lymph node clearance, and satisfied pancreatic-jejunumanastomosis.In this article, we introduced a 60-year-old woman with a preoperative diagnosis of obstructive jaundice caused by common bile duct carcinoma.A standard Whipple procedure was performed for her, with an end-to-side invagination pancreaticojejunostomy.The duration of operation was 4 hours and 30 minutes, and blood loss was 200 ml without transfusion.The patient recovered uneventfully without any complication, and was discharged 2 weeks after surgery.The pathologic results showed a moderately differentiated adenocarcinoma of the distal common bile duct , and no metastasis was found among the 22 resected lymph nodes.