保留中段的胰腺切除术

Middle⁃preserving pancreatectomy

目的探讨保留中段的胰腺切除术(MPP)的临床疗效。方法采用回顾性描述性研究方法。收集2019年7—10月福建省立医院收治的2例行MPP胰腺疾病患者的临床病理资料。病例1为52岁女性胰头、胰尾多发囊腺瘤患者,病例2为20岁男性慢性胰腺炎并胰管多发结石患者。综合评估病例1和病例2情况,制订术前规划后,分别施行腹腔镜胰头肿瘤切除+胰体尾切除+脾切除+胰肠吻合术和保留十二指肠全胰头切除+保留脾脏胰尾切除+胰管纵行切开取石+胰肠侧侧吻合术。观察指标:手术完成情况、手术时间、术中出血量、术中输血、术后血糖、术后并发症、术后住院时间、术后组织病理学检查情况、术后随访情况。采用门诊或电话方式随访,了解患者是否新发糖尿病和需要胰酶替代治疗及结石、肿瘤复发情况。随访时间截至2020年3月。结果病例1和病例2均顺利完成MPP,手术时间分别为470 min和400 min;术中出血量分别为200 mL和100 mL;2例患者术中均未输血。病例1和病例2术后血糖分别为5.4~11.8 mmol/L和5.9~11.3 mmol/L。病例1术后发生腹腔感染,经抗感染治疗后好转出院;病例2术后恢复顺利,无并发症发生。病例1和病例2均无胰瘘及围术期死亡;术后住院时间分别为12 d和8 d。病例1术后胰腺标本组织病理学检查结果示胰头、胰尾浆液性囊腺瘤。病例2术后胰腺标本组织病理学检查结果示胰头、胰尾组织胰管轻度扩张伴多发结石,胰管周围慢性炎症细胞浸润。病例1和病例2术后复查CT示保留胰腺长度分别为8.5 cm和8.3 cm。病例1和病例2均获得随访,随访时间分别为5个月和7个月。随访期间2例患者均无新发糖尿病,无需胰酶替代治疗。2例患者均于术后5个月行腹上区CT平扫及增强扫描检查,中段胰腺血运良好,无肿瘤及结石复发征象。结论MPP是治疗多灶性胰腺病变的一种安全、可行的手术方式。该手术方式可根除病灶,患者术后血糖控制良好。

Objective To investigate the clinical efficacy of middle⁃preserving pancreatectomy(MPP).Methods The retrospective and descriptive study was conducted.The clinicopathological data of two patients who underwent MPP in Fujian Provincial Hospital from July 2019 to October 2019 were collected.Case 1 was a 52⁃year⁃old woman with multiple serous cystic neoplasms of the pancreatic head and tail.Case 2 was a 20⁃year⁃old man with chronic pancreatitis and multiple pancreatic duct stones.After comprehensive evaluation,two patients were performed laparoscopic pancreatic head tumor resection+pancreatic tail resection+splenectomy+pancreaticoje⁃junostomy and duodenum⁃preserving pancreatic head resection+pancreatic tail resection+lithotomy by longitudinal pancreatic duct incision+side⁃to⁃side pancreaticojejunostomy,respectively.Observation indicators:surgery,opera⁃tion time,volume of intraoperative blood loss,blood transfusion,postoperative fasting blood glucose,postoperative complications,duration of postoperative hospital stay,postoperative pathological examination,and follow⁃up.Follow⁃up was performed using outpatient examination and telephone interview to detect new⁃onset diabetes mellitus,pancreatic enzyme replacement therapy and disease recurrence up to March 2020.Results Two patients successfully underwent MPP.The operation time of case 1 and case 2 were 470 minutes and 400 minutes,the volume of intraoperative blood loss were 200 mL and 100 mL,respectively.No blood transfusion was performed in either patient.The postoperative fasting blood glucose fluctuated between 5.4 and 11.8 mmol/L in case 1,and fluctuated between 5.9 and 11.3 mmol/L in case 2.Case 1 developed abdominal infection after operation,and was discharged after anti⁃infective treatment.Case 2 had good recovery with no complication.No pancreatic fistula or perioperative death occurred in two patients.The duration of postoperative hospital stay were 12 days and 8 days of case 1 and case 2,respectively.The pathological examination of case 1 showed serous cystadenoma of the pancreatic head and pancreatic tail.The pathological examination of case 2 showed that slightly dilated pancreatic ducts of the pancreatic head and tail with multiple stones and chronic inflammatory cells infiltration around the pancreatic ducts.The length of pancreas preserved was 8.5 cm and 8.3 cm of case 1 and case 2 on postoperative computed tomography(CT)reexamination.Two patients were followed up for 5 months and 7 months,respectively.During the follow⁃up,both patients had no new⁃onset diabetes and they didn′t require pancreatic enzyme replacement therapy.Both patients underwent upper abdominal CT examination at postoperative 5 months,which showed good blood supply in middle pancreas and no signs of recurrence of cystadenoma or stones.Conclusions MPP is a safe and feasible procedure for the treatment of multifocal pancreatic lesions.The procedure can eradicate the lesions and ensure good control of blood glucose in patients.