4例儿童胰十二指肠切除术的临床疗效分析

Clinical analysis of 4 cases of children undergoing pancreaticoduodenectomy

目的总结4例儿童胰十二指肠切除术(pancreaticoduodenectomy,即Whipple术)的手术技巧及监护治疗经验,讨论该术式在儿童中的可行性并总结术后监护的成功经验。方法回顾性分析2016年10月至2018年1月由重庆医科大学附属儿童医院行Whipple术患儿的临床资料,共4例,其中男童2例,女童2例;中位年龄6岁6个月,疾病分别为胰腺实性假乳头状瘤1例、胰母细胞瘤1例、胆管葡萄状胚胎性横纹肌肉瘤1例和B细胞淋巴母细胞瘤1例。结果4例患儿均顺利完成胰十二指肠切除术。主要临床表现为腹痛,以上腹部为著,其中3例合并黄疸,1例合并便血。CT检查均提示累及胰腺头部的实性占位,并通过手术证实。肿瘤直径4~10 cm,1例合并淋巴结转移,1例合并门静脉瘤栓。术后出现不完全性肠梗阻1例。随访3~18个月,均未发现肿瘤复发及转移。结论儿童年龄不是Whipple术的禁忌证,该术式治疗儿童累及胰腺的病变是安全可行的,术前MRI及CT检查可为手术提供安全支持,手术术式的选择应依据术前CT和术中对肿瘤部位、包膜是否完整、是否侵及周围组织的评估结果来决定,术后加强液体平衡监测及及时补液可以降低并发症的发生率。

Objective To review the clinical data of 4 cases of Wipple s procedure and summarize the experience of surgical techniques and monitoring. Methods Retrospective analysis was performed for the clinical data of 4 children undergoing Wipple s procedure from October 2016 to January 2018.Among them,there were 2 boys and 2 girls with a median age of 78 months.The etiologies were solid pseudopapillary pancreatic tumor,pancreatic blastoma,bile duct grape-embryonic rhabdomyosarcoma and B lymphoblastic neoplasms respectively. Results Wipple s procedure was performed successfully.The major clinical manifestation was abdominal pain,especially in upper abdomen.There were jaundice ( n =3) and hematochezia ( n =1).The findings of computed tomography (CT) were solid space-occupying of pancreatic head and were confirmed intraoperatively.Tumor had a diameter of 4 to 10 cm.Among them,there were lymph node metastasis ( n =1) and portal vein tumor thrombus ( n =1).Incomplete bowel obstruction occurred in 1 child after operation.No recurrence or metastasis occurred during a follow-up period of 3 to 18 months. Conclusion It is both safe and feasible to treat children with pancreatic mass by Whipple procedure.Preoperative magnetic resonance imaging (MRI) and CT provide strong preoperative supports.The choice of surgical procedures should be based on locations,with or without intact capsule and invading the surrounding tissues.Postoperative fluid monitoring and prompt rehydration may reduce the incidence of complications.