Duodenum-preserving resection and Roux-en-Y pancreatic jejunostomy in benign pancreatic head tumors

This study was conducted to explore the feasibility of partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of benign tumors of the pancreatic head(BTPH). From November 2006 to February 2009, four patients(three female and one male) with a mean age of 34.3 years(range: 21-48 years) underwent partial pancreatic head resection and Roux-en-Y pancreatic jejunostomy for the treatment of BTPH(diameters of 3.2-4.5 cm) using small incisions(5.1-7.2 cm). Preoperative symptoms include one case of repeated upper abdominal pain, one case of drowsiness and two cases with no obvious preoperative symptoms. All four surgeries were successfully performed. The mean operative time was 196.8 min(range 165-226 min), and average blood loss was 138.0 m L(range: 82-210 m L). The mean postoperative hospital stay was 7.5 d(range: 7-8 d). In one case, the main pancreatic duct was injured. Pathological examination confirmed that one patient suffered from mucinous cystadenoma, one exhibited insulinoma, and two patients had solid-pseudopapillary neoplasms. There were no deaths or complications observed during the perioperative period. All patients had no signs of recurrence of the BTPH within a follow-up period of 48-76 mo and had good quality of life without diabetes. Partial pancreatic head resection with Roux-en-Y pancreatic jejunostomy is feasible in selected patients with BTPH.

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.

Xanthogranulomatous pancreatitis treated by duodenum-preserving pancreatic head resection

BACKGROUND:Xanthogranulomatosis is an idiopathic,rare process in which lipid-laden histiocytes are deposited at various locations in the body.We present two cases who were treated by duodenum-preserving pancreatic head resection and eventually diagnosed as having xanthogranulomatous pancreatitis. METHODS:A 30-year-old caucasian man was admitted to our clinic for vague abdominal pain and epigastric dullness. Magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography suggested the existence of chronic pancreatitis.Another 34-year-old caucasian woman was admitted to our clinic because of right upper quadrant pain. Magnetic resonance cholangiopancreatography demonstrated a dilatation and stone of the main pancreatic duct.Based on a diagnosis of chronic pancreatitis,pancreatic head resection was planned and a laparotomy was performed in both of cases. RESULTS:In both cases,duodenum-preserving pancreatic head resection was performed.Macroscopic and microscopic findings revealed xanthogranulomatous inflammation,which led to a diagnosis of xanthogranulomatous pancreatitis. CONCLUSION:Although this type of pancreatitis is extremely rare,it is important to keep it in mind for a differential diagnosis because it may simulate chronic pancreatitis or a malignant tumor on imaging.

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.

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in f ive patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, preand intra-operative defi nite localization and careful operative techniques are required.

Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

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.

Pancreaticoduodenectomy for borderline resectable pancreatic head cancer with a modified artery-first approach technique

BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of BRPHC.METHODS： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two groups.RESULTS： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.

Total mesopancreas excision for pancreatic head cancer: analysis of 120 cases

Objective： To evaluate the feasibility and safety of total mesopancreas excision （TMpE） in the treatment of pancreatic head cancer. Methods： The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. Results： The mean operative time was （275.0±50.2） min and the average intra-operative blood loss was （390.0±160.5） mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.

Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?

BACKGROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be established.Current protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular resection.The aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be achieved.METHODS:Twelve patients with BRTs were identified.Tumor location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for VR.RESULTS:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate margin.Four of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade 2.LC did not influence the need for VR.CONCLUSIONS:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative imaging.Preoperative MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients.

Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer:a multicenter randomized controlled trial

Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD could be used as an effective surgical procedure for patients with pancreatic head cancer,especially those with preoperative CA19–9<200.0 U/mL.

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.

保留十二指肠胰头全切除术11例临床分析

目的 探讨保留十二指肠胰头全切除术(DPPHRt)对胰头良性及低度恶性疾病的治疗经验,包括手术适应证、手术并发症尤其是胆管并发症的防治。方法 回顾性分析2021年7月至2023年5月苏州大学附属第一医院11例施行DPPHRt患者的病例资料。结果 本组共11例,其中男7例,女4例,平均年龄55.6岁,平均手术时间249(165~390)min,平均术中出血量187(50~500)mL,平均术后住院时间27.6(12~55)d。疾病类型:慢性肿块型胰腺炎2例(1例伴胰管结石),慢性胰腺炎1例(车祸外伤所致),胰腺神经内分泌肿瘤1例,胰头导管内乳头状瘤(IPMN)5例,胰腺浆液性囊腺瘤1例,胰头黏液性囊肿1例。手术方式均为开腹手术,无手术死亡。术后发生胰瘘3例(均为B级胰瘘),胆瘘3例,胆总管狭窄3例,腹腔出血1例,腹腔感染1例,胃排空延迟2例,经非手术治疗均治愈出院。术后获得随访11例,随访时间为2个月至2年,无复发、内外分泌功能减退、胃排空延迟等远期并发症发生,无死亡病例。结论 DPPHRt对胰头良性与低度恶性疾病是一种有效的手术方式。

Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas

Standard pancreatic resections, such as pancreaticoduodenectomy, distal pancreatectomy, or total pancreatectomy, result in an important loss of normal pancreatic parenchyma and may cause impairment of exocrine and endocrine function. Whilst these procedures are mandatory for malignant tumors, they seem to be too extensive for benign or border-line tumors, especially in patients with a long life expectancy. In recent years, there has been a growing interest in parenchyma-sparing pancreatic surgery with the aim of achieving better functional results without compromising oncological radicality in patients with benign, border-line or low-grade malignant tumors. Several limited resections have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor: central pancreatectomy, duodenum-preserving pancreatic head resection with or without segmental duodenectomy, inferior head resection, dorsal pancreatectomy, excavation of the pancreatic head, middle-preserving pancreatectomy, and other multiple segmental resections. All these procedures are technically feasible in experienced hands,with very low mortality, although with high morbidity rate when compared to standard procedures. Pancreatic endocrine and exocrine function is better preserved with good quality of life in most of the patients, and tumor recurrence is uncommon. Careful patient selection and expertise in pancreatic surgery are crucial to achieve the best results.

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.

保留十二指肠的胰头切除术

目的 总结保留十二指肠的胰头切除术 (DPRHP)的经验。方法 回顾分析我院1995年 7月至 2 0 0 2年 8月以来实施该术式 9例的临床资料 ,对该术式的适应证、手术方法和并发症进行探讨 ,对术后生存质量进行评价。结果 患者手术死亡率为 0 ,胰瘘发生率 44 .4% ,无胰腺假性囊肿及腹腔脓肿形成 ,随访中无新发糖尿病患者。结论 DPRHP是一种安全、有效。

CT在判断可切除性胰头癌手术中的价值探讨

经手术、病理证实的胰头癌５９例。通过对术前ＣＴ判断肿瘤的可切除性和术后比较，其结果可切除的符合率为６４．７％，不可切除的符合率为９２．８％。ＣＴ显示肠系膜上动脉、腹腔动脉增粗，肿瘤包裹血管、血管中癌栓形成为肿瘤不可切除的可靠征象；肝转移、腹水为不可切除的完全可靠的征象，但小的转移性肝癌不易发现；淋巴结肿大并不是转移的特异征象；血管部分与肿瘤接触，脂肪层消失，有时不易区别是否为肿瘤浸润，对判断手术可切除性上可靠性低。

胰头与十二指肠的血供关系及其临床意义

目的了解胰头及十二指肠的血管走行,为在DPPHR术中如何保护十二指肠的血供及是否行Kocher操作提供更多的形态学资料。方法随机选取40具尸体,充分解剖暴露肠系膜上动脉、胃十二指肠动脉及胰十二指肠前后动脉弓,对供应十二指肠的动脉及伴行的静脉行径进行仔细观察和记录。结果在97.5%的标本中(n=39),胰十二指肠后动脉弓及伴行的静脉均位于胰后筋膜内;在90%的标本中(n=36),胰十二指肠下前动脉及伴行的静脉走行于胰十二指肠沟内,易于保留;在个别标本中(10%,n=4),没有完整的胰十二指肠前动脉弓;其中1例标本(2.5%,n=1),没有完整的胰十二指肠后动脉弓,但供应十二指肠的动脉及其伴行静脉仍位于胰后筋膜内。结论 DPPHR手术的关键在于保留胰十二指肠后动脉弓,同时尽可能地保留部分胰十二指肠前动脉弓,而Kocher操作有利于保护胰十二指肠后动脉弓;在个别标本中,没有完整的胰十二指肠前动脉弓,此时施行DPPHR可能伤及十二指肠血供,导致手术失败。

保留十二指肠的胰头切除术与胰十二指肠切除术治疗慢性胰腺炎疗效Meta分析

目的通过Meta分析的方法,对保留十二指肠的胰头切除术与胰十二指肠切除术治疗慢性胰腺炎的疗效进行评价。方法分别在PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库中检索1980年1月至2012年9月间发表的有关保留十二指肠的胰头切除术与胰十二指肠切除术治疗慢性胰腺炎的临床对照试验(包括随机和非随机研究)。分别按照入选和排除标准筛选,有9项临床试验纳入研究,提取所需数据,用RevMan5.1软件进行分析。结果保留十二指肠的胰头切除术与胰十二指肠切除术相比,手术死亡率(P=0.56)及疼痛缓解(P=0.53)差异无统计学意义,而两组手术总并发症(P<0.01)、住院时间(P<0.01)、新发糖尿病(P<0.01)、生活质量(P<0.01)等均显示保留十二指肠的胰头切除术优于胰十二指肠切除术。结论从目前资料来看,保留十二指肠的胰头切除术相比于胰十二指肠切除术,在治疗慢性胰腺炎的疗效上更具有优势。

保留十二指肠胰头切除术与胰十二指肠切除术治疗慢性胰腺炎的比较研究

目的:比较保留十二指肠胰头切除术(duodenum-preserving pancreatic head resection,DPPHR)与胰十二指肠切除术(pancreaticoduodenectomy,PD)治疗慢性胰腺炎的安全性及临床疗效。方法:回顾分析我院2004年1月至2010年12月接受DPPHR与PD的59例慢性胰腺炎病人,比较两种术式的术前数据、手术情况、术后并发症率、死亡率和术后住院天数等,用EORTC(European Organization for Research and Treatment of Cancer)QLQ-C30(Quality-of-Life Questionnaire-C30)V3.0中文版生活质量评分量表评价术后病人的生活质量。结果:共59例病人纳入研究,PD组37例,DPPHR组22例。两组术前特征无统计学差异。PD组与DPPHR组相比,在术中失血[(332±103)mL比(241±74)mL,P<0.05]、手术时间[(310±91)min比(249±71)min,P<0.05)]和术后住院天数[(14.3±9.0)d比(9.4±8.4)d,P<0.05]上,DPPHR组均优于PD组。两组病人均无术后死亡。两组术后并发症发生率(32.4%比31.8%,P>0.05)和生活质量评分两组无统计学差异,但DPPHR组评分略优于PD组。结论:DPPHR组与PD相比在缓解慢性胰腺炎病人疼痛方面有效。两组生活质量无统计学差异。两组病人在术后并发症发生率和术后死亡率上并无统计学差异,同样安全可行,在术后住院天数、术中失血和手术时间,DPPHR组优于PD组。