Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections

近端胰腺非侵袭性肿瘤剜除手术:指征及与传统标准切除手术效果比较（英文）

Objective： The aim of this study was to evaluate the safety and efficiency of enucleation（EU） for proximal pancreatic non-invasive neoplasms.Methods： Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included.Different operations and outcomes were analyzed.Results： A total of 123 patients were enrolled.Forty patients（32.5%） underwent EU including 18 patients who had tumors close to the main pancreatic duct（MPD）.Sixty-one patients（49.6%） had pancreaticoduodenectomy（PD） performed and 22（17.9%） underwent central pancreatectomy（CP）.Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors.Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group.PD was associated with the greatest complication rate（55.7%）, followed by EU（50%） and CP（40.9%）, though the pancreatic fistula rate after EU was the highest（50%）, especially in patients with tumors larger than 3 cm and tumors close to the MPD.EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function.Conclusions： EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.

目的:评价近端胰腺非侵袭性肿瘤剜除手术的安全性与有效性。创新点:以目前为止最大样本量的近端胰腺非侵袭性肿瘤的剜除手术的数据分析,证实了剜除手术在这类患者中的安全性和有效性,即使肿瘤直径>3 cm或临近主胰管肿瘤。并且首次报道和证实了在这些患者剜除手术中发生主胰管损伤,进行主胰管修补与支架置入是安全有效的。分析了同期进行不同手术方式患者的肿瘤资料,阐明了肿瘤大小影响手术策略的制定。方法:详细对比了剜除手术和传统的胰十二脂肠切除术以及胰腺中段切除术的术前情况、术中情况、术后并发症资料(表1~3),尤其详细描述了临近主胰管和主胰管有损伤的患者剜除手术后并发症情况(表4)。同时,附图说明了主胰管修补手术方法(图1)。结论:近端胰腺非侵袭性肿瘤的剜除手术是安全有效的,应该是这类患者手术治疗的首选推荐方式,在大肿瘤和临近主胰管的肿瘤患者中也可施行。