A case of chronic pancreatitis treated by laparoscopic duodenum-preserving pancreatic head resection

Pancreaticoduodenectomy(PD) has long been used for chronic pancreatitis(CP), but greatly affects the postoperative quality of life. A new procedure called duodenum-preserving pancreatic head resection(DPPHR) has been introduced, and has little effect on the structure and function of the digestive system. With the development of minimally invasive surgical techniques, treatment of CP can be performed with laparoscopic DPPHR(LDPPHR). We present a case of CP that was successfully treated with LDPPHR. The postoperative pathological diagnosis was pancreatitis, demonstrating the feasibility of LDPPHR. We recommend this minimally invasive surgical method as preferred treatment for CP.

Preoperative 3D reconstruction and fluorescent indocyanine green for laparoscopic duodenum preserving pancreatic head resection:A case report

BACKGROUND Duodenum-preserving pancreatic head resection(DPPHR)is the choice of surgery for benign or low-grade malignant tumors of the pancreatic head.Laparoscopic DPPHR(LDPPHR)procedure can be improved by preoperative 3D model reconstruction and the use of intravenous indocyanine green fluorescent before surgery for real-time navigation with fluorescent display to guide the surgical dissection and prevention of from injury to vessels and biliary tract.CASE SUMMARY Here we report the successful short-and long-term outcomes after one year following LDPPHR for a 60-year lady who had an uneventful recovery and was discharged home one week after the surgery.CONCLUSION There was no bile leakage or pancreatic leakage or delayed gastric emptying.The histopathology report showed multiple cysts in the pancreatic head and localized pancreatic intraepithelial tumor lesions.The resected margin was free of tumor.

Quality of life after pancreatic surgery

BACKGROUND Pancreatic surgery is challenging owing to the anatomical characteristics of the pancreas.Increasing attention has been paid to changes in quality of life(QOL)after pancreatic surgery.AIM To summarize and analyze current research results on QOL after pancreatic surgery.METHODS A systematic search of the literature available on PubMed and EMBASE was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Relevant studies were identified by screening the references of retrieved articles.Studies on patients’QOL after pancreatic surgery published after January 1,2012,were included.These included prospective and retrospective studies on patients'QOL after several types of pancreatic surgeries.The results of these primary studies were summarized inductively.RESULTS A total of 45 articles were included in the study,of which 13 were related to pancreaticoduodenectomy(PD),seven to duodenum-preserving pancreatic head resection(DPPHR),nine to distal pancreatectomy(DP),two to central pancre-atectomy(CP),and 14 to total pancreatectomy(TP).Some studies showed that 3-6 months were needed for QOL recovery after PD,whereas others showed that 6-12 months was more accurate.Although TP and PD had similar influences on QOL,patients needed longer to recover to preoperative or baseline levels after TP.The QOL was better after DPPHR than PD.However,the superiority of the QOL between patients who underwent CP and PD remains controversial.The decrease in exocrine and endocrine functions postoperatively was the main factor affecting the QOL.Minimally invasive surgery could improve patients’QOL in the early Core Tip:This review summarizes and analyzes current research results on quality of life(QOL)after pancreatic surgery.The article covers the discussion and analysis of the QOL of various pancreatic surgeries.Which kind of surgical procedure has better QOL is controversial.The long-term benefits on QOL of minimally invasive surgery over open surgery are contro-INTRODUCTION The pancreas,located in the retroperitoneum,is a glandular organ with endocrine and exocrine functions.It can be divided into four main parts:Head,neck,body,and tail.Pancreatic surgery can be divided into pancreaticoduoden-ectomy(PD),duodenum-preserving pancreatic head resection(DPPHR),distal pancreatectomy(DP),central pancre-atectomy(CP),and total pancreatectomy(TP).Pancreatic surgery is challenging due to the organ’s complex anatomical structure,peripheral vascularity,and intractable postoperative complications.Following the standardization of surgical steps and improvements in relevant medical techniques and surgical instruments,the safety of pancreatic surgery has significantly improved.Perioperative morbidity,mortality,and other related indicators have become more acceptable.However,owing to the organ’s essential role in digestion,absorption,and blood glucose regulation,changes in the quality of life(QOL)of patients after pancreatic surgery have attracted the attention of surgeons.More patients with non-malignant pancreatic diseases are willing to undergo surgical treatment because of the acceptable safety.In this case,from the perspective of the patient postoperatively,the significance of rehabilitation reflects the traditional perioperative outcome and QOL[1].The QOL is a new concept that extends beyond health.Although there is no consensus on its conception[2],we can consider it a multi-dimensional architecture that incorporates objective and individual subjective views of aspects of one’s physical,psychological,and social well-being[3-5].It includes evaluating physical health,and many subscales,such as emotion,job,culture,family,sociability,economy,cognition,happiness,sex,and some symptoms[6].Since people have realized the importance of QOL,many QOL scales have emerged,including the European Organization for Research and Treatment of Cancer QLQ-C30,European Quality of Life 5-dimension,36-item Short,etc.However,it is challenging to follow up on patients’QOL once they are discharged from the hospital.Consequently,most relevant studies had small sample sizes or lacked long-term follow-up results.Moreover,a summary of studies on QOL after pancreatic surgery is lacking.This study assessed the QOL in patients who underwent PD,DPPHR,DP,CP and TP.We conducted this study to describe the existing findings on the QOL after pancreatic surgery to make it easier for surgeons and patients to decide on a surgical approach.In addition,we attempted to identify controversial results to encourage further targeted research.

Laparoscopic duodenum-preserving pancreatic head resection:a narrative review

Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma,damage to adjacent organs,a long operation time and a high incidence of postoperative complications.Since the early 1990s,laparoscopic techniques have been applied to a growing number of pancreas surgeries,and great progress has been achieved in laparoscopic pancreaticoduodenectomy.As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques,laparoscopic techniques are gradually used in other pancreatic surgeries,such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection(LDPPHR),which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity.Recently,a great number of literature have introduced LDPPHR.It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head.Although LDPPHR is technically feasible,it is not yet generally practicable and limited to highly skilled endoscopic surgeons,and the long-term results after LDPPHR are still not well defined.This article aims to provide a literature review of LDPPHR to assess its feasibility,safety,postoperative recovery,and future outlook according to early experiences of this technique.

Surgical Treatment of Chronic Pancreatitis in Young Patients

The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were ana- lyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of stea- torrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP in- tervention on delaying the progression of the disease and relieving the symptoms.

改良保留十二指肠胰头切除术治疗慢性胰腺炎的疗效分析

目的:观察改良保留十二指肠的胰头切除术(改良Beger手术)对伴胰头炎性肿块的慢性胰腺炎病人的治疗效果。方法:回顾性分析自2004年1月至2010年12月,在我院胰腺外科接受改良Beger手术治疗的51例伴胰头炎性肿块的慢性胰腺炎病人的临床资料,并对病人术后疼痛症状、生活质量及内分泌功能等进行随访。结果:无手术死亡病例,术后并发症发生率为15.7%,其中胰漏3例,胆漏2例,十二指肠漏1例,腹腔出血1例,切口裂开1例。术后6个月,病人疼痛得到明显缓解,EORTC QLQ-C30疼痛评分由(64.3±5.8)降至(12.5±3.7)(P<0.01),生活质量获显著提高,GLQI生活质量评分由(70.1±5.8)增至(86.4±6.6)(P<0.01);病人内分泌功能未受影响,无新增糖尿病病例。结论:采用改良Beger手术治疗伴胰头炎性肿块的慢性胰腺炎是安全、有效的。

Beger术式在胰头部手术治疗中的应用

目的总结Beger术式在临床胰头部手术治疗中的应用经验。方法对1999年10月-2007年5月4例住院病人施行了Beger术式并对手术适应证以及手术技能进行了分析讨论。结果本文病例的Beger手术均顺利进行，手术死亡率为0，仅1例发生胰瘘，且治愈恢复良好。结论对于胰头部的良性疾患，Beger术式是可行且安全有效的手术方式。

再谈保留十二指肠的胰头切除术

随着外科技术水平的提高和对解剖认知的深入,精准外科理念逐步发展,传统大范围联合器官切除治疗良性及交界性肿瘤因较高的远期并发症风险,其必要性面临挑战。以保留十二指肠的胰头切除术为代表,40年来不断有各种改良术式出现,手术指征逐步从慢性胰腺炎过渡到胰头部良性及交界性肿瘤;切除范围也从胰头大部切除、次全切除向胰头全切除转变;手术方式从既往单纯开放手术转变到目前腹腔镜或机器人辅助等微创入路术式,体现出治疗理念、手术方式的更新与优化。本文对保留十二指肠的胰头切除术的发展历程、手术指征及其相关并发症予以论述,以期为临床中更规范、合理地选择该术式提供参考,同时降低并发症发生率。

微创保留十二指肠的胰头切除术治疗胰头良性和交界性肿瘤的临床效果分析

目的探讨微创保留十二指肠的胰头切除术(DPPHR)治疗胰头良性和交界性肿瘤的临床效果。方法回顾性分析2015年10月至2021年9月于浙江省人民医院胃肠胰外科因胰头良性或交界性肿瘤行腹腔镜或机器人DPPHR的33例患者资料。男性10例,女性23例,年龄[M(IQR)]54(32)岁(范围:11~77岁),体重指数21.9(2.9)kg/m^(2)(范围:18.1~30.1 kg/m^(2))。临床症状:腹痛12例,Whipple三联征2例,无症状因体检发现19例。合并高血压7例,糖尿病1例。美国麻醉医师协会评分:Ⅰ级19例,Ⅱ级14例。定量资料的组间比较采用Student t检验或U检验;分类资料的组间比较采用χ^(2)检验或Fisher确切概率法。结果33例患者中,14例行腹腔镜DPPHR,19例行机器人DPPHR。重建方式:胰胃吻合5例,胰肠吻合28例。术后病理学检查结果显示,导管内乳头状黏液腺瘤9例,实性假乳头状瘤9例,浆液性囊腺瘤7例,神经内分泌瘤6例,黏液性囊腺瘤1例,慢性胰腺炎1例。手术时间(309.4±50.3)min(范围:180~420 min),术中出血量(97.9±48.3)ml(范围:20~200 ml)。围手术期出现并发症18例,其中3例出现严重并发症(Clavien-Dindo并发症分级≥Ⅲ级)。发生胰瘘16例,其中生化漏8例,B级胰瘘7例,C级胰瘘1例。无围手术期死亡病例。术后住院14(7)d(范围:6~87 d)。术后随访22.6(24.5)个月(范围:2~74个月),未见肿瘤复发,2例出现脂肪泻伴体重下降,1例于术后12个月并发非酒精性脂肪性肝病,无术后新发糖尿病。所有患者术后均未出现胆道狭窄及反流性胆管炎。结论微创DPPHR治疗胰头良性和交界性肿瘤是可行的,可保留更多的胰腺内外分泌功能,避免胆道并发症。

肠系膜上静脉右侧间隙入路在保留十二指肠的胰头切除术治疗慢性胰腺炎合并胰头结石中的应用价值

目的:探讨肠系膜上静脉右侧间隙入路在保留十二指肠的胰头切除术(又称Beger术)治疗慢性胰腺炎合并胰头结石中的应用价值。方法:采用回顾性描述性研究方法。收集2015年1月至2017年5月上海交通大学医学院附属仁济医院收治的3例慢性胰腺炎合并胰头结石患者的临床资料。3例患者均施行经肠系膜上静脉右侧间隙入路Beger术,即紧贴肠系膜上静脉右侧缘解剖胰颈后隧道,逐步离断胰颈。观察指标:(1)手术情况。(2)术后情况。(3)术后病理学检查情况。(4)随访情况。采用门诊方式进行随访,随访内容为患者腹痛、腹泻、畏寒、发热、黄疸等临床表现,血糖、肝功能和肿瘤标志物检查,腹部超声、MRI或CT检查判断有无结石残留和复发。随访时间截至2017年12月。正态分布的计量资料以平均数(范围)表示。结果:(1)手术情况:3例患者均成功采用肠系膜上静脉右侧间隙入路行保留十二指肠的胰头切除术,其中1例联合胆总管囊肿切除术,无围术期死亡患者。3例患者手术时间为400min(360~480min),胰腺颈部离断时间为20min(15~25min),术中出血量为117mL(50~200mL)。(2)术后情况:3例患者术后首次下床活动时间为4d(3~5d),术后首次肛门排气时间为3d(2~3d),术后恢复饮水时间为3d(2~4d)。1例患者出现胰腺生化漏和胃瘫,经腹腔引流和对症治疗好转,术后30d带管出院,术后47d来院拔除腹腔引流管。1例患者出现胰腺生化漏,经腹腔引流和对症治疗好转,术后28d带管出院,术后48d来院拔除腹腔引流管。1例患者术后恢复平稳,未出现胰液漏、胃瘫等并发症,术后13d拔除腹腔引流管出院。(3)术后病理学检查情况。3例患者术后病理学检查结果显示:均为慢性胰腺炎、胰腺导管扩张伴结石形成,其中1例合并胆总管囊肿伴上皮轻度不典型增生。(4)随访情况:3例患者均获得术后随访,随访时间为17~27个月。随访期间,3例患者饮食情况良好,生存良好,均未出现腹痛、腹泻、畏寒、发热、黄疸等临床表现,血糖控制良好,肝功能和肿瘤标志物正常,均无胰管结石残留和复发。结论:肠系膜上静脉右侧间隙入路离断胰颈的Beger术治疗慢性胰腺炎合并胰头结石安全有效。

胰十二指肠切除术与保留十二指肠胰头次全切除术治疗胰头肿块型慢性胰腺炎的临床疗效

目的探讨胰十二指肠切除术（PD）和保留十二指肠胰头次全切除术（DPPHR，包括Beger术、Frey术、Berne术）治疗胰头肿块型慢性胰腺炎的临床疗效。方法回顾性分析2007年1月至2013年12月武警湖南省总队医院收治的13例和中南大学湘雅三医院收治的35例慢性胰腺炎患者的临床资料。根据患者临床症状、影像学表现和术中病理学检查结果选择手术方式。其中23例行PD（经典Whipple术或保留幽门的PD）患者为PD组，25例行DPPHR术（Beger术、Frey术或Berne术）患者为DPPHR组。分析两组患者的手术时间、术中出血量、术后疼痛缓解率、胰腺内外分泌功能改变、手术并发症、术后住院时间、住院费用等指标。通过电话和门诊复查等方式随访，随访时间截至2014年9月。正态分布的计量资料以x±s表示，两组比较采用t检验；计数资料采用χ2检验及其校正公式或Fisher确切概率法。结果PD组23例患者中，行Whipple术15例，行保留幽门PD8例；DPPHR组25例患者中，行Beger术8例，Frey术13例，Berne术4例。PD组和DPPHR组患者的手术时间、术中出血量分别为（5．5±0．4）h和（4．2±0．6）h，（372±174）mL和（272±114）mL，两组比较，差异均有统计学意义（t=8．712，2．375，P〈0．05）。PD组有3例患者术中出现大出血，DPPHR组2例行Beger术患者术中损伤门静脉出现大出血；两组比较，差异无统计学意义（χ2=0．010，P〉0．05）。两组患者术中快速冷冻切片病理学检查结果均为胰腺慢性炎症改变，伴纤维组织增生。PD组患者术后疼痛总缓解率为95．7％（22／23），其中疼痛完全缓解20例，疼痛缓解2例；DPPHR组患者术后疼痛总缓解率为92．0％（23／25），其中疼痛完全缓解18例，疼痛缓解5例；两组患者术后疼痛总缓解率比较，差异无统计学意义（χ2=0．000，P〉0．05）。PD组患者术后糖尿病发病率为38．9％（7／18），消化不良和脂肪泻发生率为35．7％（5／14）；DPPHR组分别为9．5％（2／21）和20．0％（3／15），两组患者比较，差异均无统计学意义（χ2=3．200，0．281，P〉0．05）。PD组患者术后并发症发生率为30．4％（7／23），其中合并腹腔出血、胰液漏及局限性腹膜炎患者1例，胰液漏1例，胆瘘2例，胃排空延迟3例。胰液漏和胆瘘患者经充分引流约1周后痊愈。DPPHR组患者术后1例患者发生胰液漏，并发症发生率为4．0％（1／25）。两组患者术后并发症发生率比较，差异有统计学意义（χ2=4．274，P〈0．05）。PD组患者术后住院时间和住院费用分别为（12．4±2．5）d和（57751±6772）元，DPPHR组分别为（8．2±1．8）d和（49109±6168）元，两组比较，差异均有统计学意义（t=6．576，4．645，P〈0．05）。48例患者获得随访，平均随访时间为51．6个月（9．0～92．0个月）。随访期间2例患者死亡，1例行Frey术，术后半年再次出现腹上区疼痛并确诊为胰腺癌，确诊后3个月死亡；1例行PD，术后2年因心血管系统疾病死亡。随访患者中1例半年后再行胆肠引流术，其余患者随访期间未出现复发和癌变。结论DPPHR用于治疗胰头肿块型慢性胰腺炎安全有效，具有手术时间短、术中出血量少、术后恢复快、住院时间短并延迟胰腺内外分泌功能减退等优势。但DPPHR不能完全替代PD，因此，需把握各类手术的适应证，结合病变特点选择合适的手术方式。