青少年胰头部肿瘤微创手术15例临床分析

Early experience of minimal invasive surgery for adolescent with pancreatic head tumor: a report of 15 cases

目的总结青少年胰头部肿瘤微创手术治疗的特点和难点。方法回顾性分析2014年1月至2019年12月在浙江省人民医院胃肠胰外科因胰头部肿瘤行微创手术治疗的、年龄<28岁的15例患者资料。男性5例,女性10例。中位年龄20岁(范围:11~27岁),体重指数(19.8±2.3)kg/m^2(范围:17.3~21.6 kg/m^2)。结果12例患者接受标准胰十二指肠切除术,其中腹腔镜手术9例,机器人手术3例;1例接受腹腔镜胰十二指肠切除术联合结肠肝曲切除术;2例接受机器人保留十二指肠胰头切除术+胰胃吻合。手术时间(269.0±65.1)min(范围:150~410 min),术中出血量(135.6±52.7)ml(范围:50~400 ml)。围手术期6例发生并发症,其中胰腺生化漏1例,胆瘘1例,胃肠吻合口出血及肠粘连梗阻1例,乳糜漏1例,切口感染1例,肝损伤1例。中位住院时间为13 d(范围:9~22 d)。术后病理学检查结果:实性假乳头状瘤8例,神经内分泌肿瘤3例,胰腺导管内乳头状黏液瘤1例,胰腺囊性纤维瘤1例,胰腺浆液性囊腺瘤1例,尤因肉瘤1例。术后中位随访时间为37个月(范围:2~75个月),尤因肉瘤患者无瘤生存43个月,术后63个月死亡,其余患者均无瘤生存。3例发生远期胆道并发症。结论青少年胰头部肿瘤多为良性,适合微创手术,应尽量争取行保留功能的术式。患者及家属对手术安全性和生活质量要求高,要重视围手术期管理及沟通交流。

Objective To summarize the characteristics and difficulties of minimal invasive surgery for adolescent with pancreatic head tumor.Methods The data of adolescent younger than 28 years old with pancreatic head tumor treated at Department of Gastroenterology and Pancreatic Surgery,Zhejiang Province People′s Hospital from January 2014 to December 2019 were analyzed retrospectively.Fifteen cases were enrolled,included 5 males and 10 females.The median age was 20 years(range:11 to 27 years)and the body mass index was(19.8±2.3)kg/m2(range:17.3 to 21.6 kg/m2).Results Standard pancreaticoduodenectomy was performed in 12 cases,including 9 cases of laparoscopic surgery and 3 cases of robotic-assisted surgery,and laparoscopic pancreaticoduodenectomy with resection of hepatic flexure of colon was performed on 1 case,and robotic-assisted duodenum-preserving pancreatic head resection with pancreatogastrostomy was performed on other 2 cases.The operative time was(269.0±65.1)minutes(range:150 to 410 minutes),and the blood loss was(135.6±52.7)ml(range:50 to 400 ml).Six patients got postoperative complications with gastrointestinal bleeding biochemical leakage and intestinal obstruction(n=1),pancreatic biochemical leakage(n=1),bile leakage(n=1),chylous leakage(n=1),wound infection(n=1),hepatic injury(n=1).The median postoperative hospital stay was 13 days(range:9 to 22 days).The pathologic findings were solid pseudopapillary neoplasms(n=8),neuroendocrine neoplasms(n=3),introductal papillary mucinous neoplasm(n=1),cystic fibroma(n=1),serous cystadenoma(n=1),Ewing sarcoma(n=1).The median follow-up was 37 months(range:2 to 75 months).The patient with Ewing sarcoma was diagnosed as liver metastasis at 41 months after surgery and died at 63 months after surgery.All the other patients survived without tumor.Three patients got the long-term complication of bile duct.Conclusions Most of pancreatic head tumors for adolescent are benign or low malignant.Minimally invasive surgery be the first choice,and function-preserving surgery should be taken into account as much as possible.Perioperative management and communication is essential as the parents pay much attention to the quality of life after surgery.