保留十二指肠全胰头切除术

Duodenum-preserving pancreatic head resection：two case reports with medical video

随着损伤控制性手术和器官功能保留理念的广泛接受,对于胰头良性和低度恶性肿瘤目前多主张行保留十二指肠胰头切除术（DPPHR）,但该手术局部解剖及血供复杂,手术操作难度较大,术后易发生胆道和十二指肠缺血等并发症,国内外报道的例数较少。在这里我们报道2例保留十二指肠全胰头切除术,其中1例胰头浆液性囊腺瘤患者实施胰头全切除、胰胃吻合术;1例胰头肿块型胰腺炎患者行胰头全切除、胰空肠吻合术。病例1术后1周发生急性上消化道出血,经制酸、止血、生长抑素等治疗后血止痊愈出院;病例2术后发生A级胰瘘,经引流保守治疗后痊愈出院。DPPHR的操作要点在于完整切除胰头及病变组织、保障十二指肠和胆总管下端血供,防止十二指肠和胆道缺血性损伤。

With the wide acceptance of the concept of damage control surgery and organ function preservation,duodenum-preserving pancreatic head resection（DPPRH）is commonly advocated to patients with benign and low malignant neoplasms.But because of complex local anatomy and blood supply,difficulty of operation,and high postoperative complications such as biliary and duodenal ischemia,the case reports are rare.We described two cases of DPPHR here,with total pancreatic head resection and pancreastic gastric anastomosis performed for one patient with serous cystadenoma of the pancreatic head,and total pancreatic head resection and pancreaticojejunostomy performed for the other patient of pancreatitis with pancreatic head mass.For case 1,acute upper digestive tract hemorrhage occurred one week after operation,and was cured and discharged after treatment with acid,hemostasis and somatostatin.Case 2 had Grade A pancreatic fistula complication after the operation,and was recovered and discharged after conservative treatment.The main points of the DPPHR procedure is the en bloc removal of the pancreatic head and the pathologic tissue,ensuring the blood supply of the duodenum and the inferior extremity of the common bile duct,to prevent the ischemia damage of the duodenum and bile duct.