中段胰腺切除术治疗胰颈体良性肿瘤对胰腺外分泌功能的影响

Middle segment pancreatectomy in treatment for benign pancreatic tumors and its effect on pancreatic exocrine function

目的探讨中段胰腺切除术（middlesegment pancreatectomy，MSP）治疗胰颈体良性肿瘤对胰腺外分泌功能的影响。方法收集2010年1月至2013年2月在内蒙古医科大学附属医院住院治疗的19例行MSP的胰颈体良性肿瘤患者，手术前后检测胰腺外分泌功能。结果无围手术期死亡病例。肿物直径4．2～7．0cm，手术时间80～320min，术中失血量200～1000ml，术中胰头侧胰腺保留〉1．5cm，胰尾侧胰腺除保留〉5cm；术后第3天的腹腔引流液和淀粉酶分别为2．5—12．5ml和568．4—1013．0IU几，第7天的腹腔引流液和淀粉酶分别为1．0～19.8ml和45．4～76．3IU／L；术后住院时间10-25d。术后发生胰瘘3例，均为单吻合术者，均在未行再次手术处理的情况下3个月自行愈合。术后随访2个月至3年，除1例失访外，所有患者生活质量良好，无新发糖尿病和肿瘤再发。18例胰颈体良性肿瘤患者行MSP前后与正常对照组的胰腺外分泌功能相比差异无统计学意义（P〉0．05）。结论中段胰腺切除术治疗胰颈体良性肿瘤创伤小，并发症少，较好地保存了胰腺功能，有利于改善病患的生活质量，该术式安全可行。

Objective To investigate the application of middle segment pancreatectomy （MSP） in treat- ing benign pancreatic tumors and the effect on exocrine function. Methods From Jan. 2010 to Feb. 2013, 19 cases with benign pancreatic tumor undergoing MSP were enrolled in our study. Pre-and postoperative pancreatic exocrine function were studied. Results No perioperative death happened. The tumor diameter was 4.2 to 7.0 cm, operative time was 80 to 320 mins, and intraoperative blood loss was 200 to 1000 ml. The retained pancreas was〉0.5 cm at pancreatic head side, and〉5 cm at pancreatic caudal side. Three days after surgery, the peritoneal drainage and amylase was 2.5-12.5 ml and 568.4-1013 IU/L, respectively. Seven days after surgery, the peri- toneal drainage and amylase was 1.0-19.8 ml and 45.4-76.3 IU/L, respectively. The postoperative hospitalization stay were 10 to 25 days. Three cases （all single anastomosis） had pancreatic fistula after surgery and healed after 3 months without undergoing surgery again. Patients were followed up for 2 months to 3 years. All patients have a good life quality, without new-onset diabetes and cancer recurrence. MSP had no side effects on pancreatic ex- ocrine function. Conclusion MSP is safe and feasible in treatment of benign pancreatic tumors.