保留十二指肠胰头切除术的临床应用及进展

Clinical application and progress of duodenum-preserving pancreatic head resection

目的总结保留十二指肠胰头切除术(DPPHR)在临床应用的研究进展情况。方法对近年来有关DPPHR临床应用研究的文献进行综述。结果对于胰头部良性病变、低度恶性及交界性肿瘤,DPPHR能够达到与经典的胰十二指肠切除术同样的预期治疗效果,其在切除病变、改善患者症状的同时可保留胃、十二指肠等的连续性,减少了消化道的重建,尽可能地减少了胰腺及周围组织的切除,保留了胰-肠轴,更符合人的生理。结论就目前而言,DPPHR值得在胰腺外科进一步发展推广,但目前的研究均只关注了患者术后短期内并发症的发生情况,由于胰头部良性疾病患者的预后较好、术后存活时间较长,因此应关注腹泻、贫血、反流性胆管炎等远期并发症,未来尚需更多的临床研究来验证DPPHR临床疗效的优越性,并着重利用多项评价指标综合分析评价患者术后远期并发症的发生情况及其对生活质量的影响。

Objective To summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR). Method The relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed. Results For the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings. Conclusions At present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.