保留管状胃胰十二指肠切除术的应用价值

Application value of pancreatoduodenectomy with preservation of the gastric tube

目的探讨保留管状胃胰十二指肠切除术的应用价值。方法采用回顾性描述性研究方法。收集2018年5月至2019年11月南京大学医学院附属鼓楼医院收治的3例壶腹部周围肿瘤行保留管状胃胰十二指肠切除术病人的临床病理资料;均为男性;中位年龄为76岁, 年龄范围为66~77岁。3例病人均有食管肿瘤根治性切除+管状胃手术史, 行保留管状胃胰十二指肠切除术。观察指标:(1)术前三维重建情况。(2)手术及术后情况。(3)随访情况。采用门诊或电话方式进行随访, 了解病人术后生存及肿瘤复发转移情况。随访时间截至2021年4月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果 (1)术前三维重建情况:3例病人术前三维重建检查均未见血管变异。(2)手术及术后情况:3例病人均顺利完成保留管状胃胰十二指肠切除术, 手术时间为402 min(345~480 min), 术中出血量为330 mL(300~400 mL)。3例病人中, 术后B级胰瘘和乳糜漏各1例, 均经保守治疗后好转。围手术期无死亡病例。3例病人术后住院时间为18 d(15~20 d)。3例病人术后病理学检查结果显示:1例胰腺癌分期为T2N0M0期;1例壶腹癌分期为T2N0M0期;1例为胰腺导管内乳头状黏液肿瘤。(3)随访情况:3例病人均获得随访, 随访时间为12~18个月, 中位随访时间为16个月。3例病人术后14个月复查增强CT示胰腺周围胃网膜右动、静脉通畅。1例胰腺癌病人术后未行化疗, 术后14个月因肿瘤复发转移死亡, 另2例病人未出现复发转移。结论保留管状胃胰十二指肠切除术安全、可行, 可用于有食管肿瘤根治切除+管状胃手术史的壶腹部周围病变病人。

Objective To investigate the application value of pancreatoduodenectomy(PD)with preservation of the gastric tube.Methods The retrospective and descriptive study was conducted.The clinicopathological date of 3 male patients who underwent PD with preservation of the gastric tube for the treatment of periampullary tumor in Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School from May 2018 to November 2019 were collected.The 3 patients were aged from 66 to 77 years,with a median age of 76 years.All 3 patients with surgical history of radical resection of esophageal tumors and tubular gastric surgery underwent PD with preservation of the gastric tube.Observation indications:(1)preoperative three-dimensional(3D)reconstruction;(2)surgical and postoperative situations;(3)follow-up.Follow-up using outpatient exa-mination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to April 2021.Measurement date with skewed distribution were expressed as M(range).Count date were expressed as absolute numbers.Results(1)Preoperative 3D reconstruction:results of preoperative 3D reconstruction for the 3 patients showed none of patients with vascular variation.(2)Surgical and postoperative situations:3 patients underwent PD with preservation of the gastric tube successfully.The operation time and the volume of intraoperative blood loss were 402 minutes(range,345-480 minutes)and 330 mL(range,300-400 mL)for the 3 patients.Of 3 patients,1 case had postoperative grade B pancreatic fistula and 1 case had chylous leakage,respectively,who were improved after conservative treatment.There was no perioperative death.The duration of postoperative hospital stay was 18 days(range,15-20 days)for the 3 patients.Results of postoperative histopathological examination for the 3 patients showed that 1 case with pancreatic cancer as T2N0M0 stage,1 case with ampulla carcinoma as T2N0M0 stage and 1 case with intraductal papillary mucinous neoplasms of the pancreas.(3)Follow-up:3 patients were followed up for 12 to 18 months,with a median follow-up time of 16 months.Results of abdominal enhanced computed tomography examination at postoperative 14 month for the 3 patients showed that the right gastroepiploic artery and vein around the pancreas were unobstructed.Of 3 patients,1 case with pancreatic cancer who did not receive chemotherapy died at postoperative 14 months due to tumor recurrence and metastasis.There was no recurrence and metastasis in the other two cases.Conclusion PD with preservation of the gastric tube is safe and feasible,which can be used for patients with periampullary lesions who underwent radical resection of esophageal tumors and tubular gastric surgery in the past.