全胰腺切除术9例临床疗效分析

Clinical effect of total pancreatectomy in 9 cases

目的探讨全胰腺切除术(total pancreatectomy,TP)治疗中晚期胰腺癌的临床疗效.方法2019年6月~2020年6月施行TP病人9例.分析病人术前一般资料、手术时间、术中出血量、术中门静脉阻断时间、术后并发症发生情况.结果9例病人均成功施行全胰腺切除+空肠造口术,其中4例病人因胰腺肿瘤累及门静脉/肠系膜上静脉,行血管切除重建.9例病人手术时间为300~540分钟,平均(385±55)分钟;术中出血量200~1800 ml,平均(475±205)ml;术中门静脉阻断时间19~45分钟,平均(26±7)分钟;术后住院时间为12~35天,平均(17±5)天.TP术后最常见的并发症为术后脆性糖尿病,本组7例,其次为术后胃排空障碍,2例出现术后胃排空障碍,1例出现腹腔出血,1例出现胆漏,1例出现结肠漏.随访6个月,死亡1例,肝转移1例,全身多发转移1例,其余5例病人生存状况良好.结论TP对于多发性胰腺癌及胰腺神经内分泌肿瘤(多部位)等中晚期胰腺癌病人可减少消化道重建,减少并发症,手术疗效确切.

Objective To investigate the clinical effect of total pancreatectomy in the treatment of advanced pancreatic cancer.Methods Clinical data of 9 TP patients administered were analyzed retrospectively in the pancreatic center of Ruijin Hospital affiliated to Shanghai Jiaotong University Medical College from June 2019 to June 2020.The clinical effect was discussed by analyzing the data of preoperative general data,operation time,intraoperative bleeding volume,intraoperative portal vein occlusion time and postoperative complications.Results Total pancreatectomy plus jejunostomy was successfully performed in 9 patients,of which 4 patients underwent vascular resection and reconstruction due to pancreatic tumor involvement of portal vein/superior mesenteric vein.The operation time of 9 patients was 300~540 min,with an average of(385±55)min.The intraoperative blood loss ranged from 200 to 1800 ml,with an average of(475±205)ml.The intraoperative time of portal vein occlusion was 19~45min,with an average of(26±7)min.The postoperative hospital stay was 12~35 days,with an average of(17±5)days.The most common complication after TP was postoperative fragile diabetes(7 cases),followed by postoperative gastric emptying disorder(2 cases),abdominal hemorrhage(1 case),biliary fistula(1 case),and colon fistula(1 case).After 6 months of follow-up,1 patient died,1 patient had liver metastasis,1 patient had multiple systemic metastasis,the remaining 5 patients had good survival.Conclusion TP can reduce digestive tract reconstruction and complications in patients with multiple pancreatic cancer and pancreatic neuroendocrine tumors(multiple sites)and other middle and advanced pancreatic cancer.With definite surgical effect,TP can be used in patients with clinical indications.