中段胰腺切除治疗胰颈体部肿瘤13例体会

Middle pancreatectomy for tumors of the neck and body of the pancreas:a report of 13 cases

目的 总结中段胰腺切除治疗胰颈体部肿瘤的临床经验.方法 对胰颈体部良性或低度恶性肿瘤13例患者行中段胰腺切除术治疗.术中游离胰颈体部切除肿瘤,行Roux-en-Y胰肠吻合或胰胃吻合.单吻合法5例,“Ω”形双吻合法6例,胰胃吻合法2例,胰肠吻合均放置肠造口管充分减压引流.结果 切除胰腺平均直径4.3 cm,手术时间（237±43）分钟,出血量（287±75） ml.术后胰瘘2例,出血2例.浆液性囊腺瘤2例,黏液性囊腺瘤1例,实性假乳头状瘤3例,导管内乳头状黏液瘤2例,神经内分泌瘤1例,神经鞘瘤1例,功能性胰岛细胞瘤2例,无功能性胰岛细胞瘤1例.均痊愈出院,平均住院时间（18±5）天,随访9个月～3年未见低血糖和肿瘤复发及新发糖尿病.结论 个体化中段胰腺切除术适合胰颈体部良性或低度恶性肿瘤治疗,保护了胰腺内外分泌功能,是一种安全、疗效确切的手术方式.

Objective To summarize the experience of middle pancreatectomy （MP） for tumors of the neck and body of the pancreas. Methods A total of 13 patients were treated with MP for benign or low-grade malignant tumors of the neck and body of the pancreas. MP was performed to remove the tumors. Digestive tract was reconstructed through Roux-en-Y pancreaticojejunostomy or pancreatogastrosto- my. The methods of operation included single anastomosis in five cases, double anastomosis in six cases and pancreatogastrostomy in two cases. The jejunostomy tube was placed in the pancreaticojejunostomy to achieve effective decompression and drainage. Results The average length of removed pancreas was 4.3 cm. The average operating time was （237 ± 43 ） min. The average amount of blood loss was （287 ± 75 ） ml. Pancreatic fistula occurred in two case. Postoperative bleeding occurred in two cases. The diseases includ- ed two cases of serous cystadenoma, one case of mucinous cystadenoma, three cases of solid pseudopapil- lary tumor,two cases of intraductal papillary mueinous neoplasm, one case of neuroendocrine neoplasm, one ease of schwannoma,two cases of functional islet cell tumor and one case of non-functioning islet cell tumor. All patients were cured and discharged. The average hospital stay was（ 18 ± 5 ） days. There were no recurrent hypoglycemia, neoplasm or diabetes after a follow-up period of nine months to three years. Con clusion Individualized MP is a proper, safe and effective technique for benign or low-grade malignant tumors located from the neck and body of the pancreas, which can maintain the endocrine and exocrine functions of the pancreas.