中段胰腺切除术在胰腺实性假乳头状瘤治疗中的应用及疗效分析

目的 为中段胰腺切除术在胰腺实性假乳头状瘤治疗中的合理应用提供一定依据。方法 回顾性分析2010年1月至2015年12月在海军军医大学附属长海医院接受胰腺手术的患者临床病例资料,筛选病理结果为实性假乳头状瘤且肿瘤位于胰腺颈部或近体部的病例。根据手术方案分为中段胰腺切除术组（central pancreatectomy,CP）和远端胰腺切除术组（distal pancreatectomy,DP）,比较两组患者的术中情况、术后并发症发生率及复发率情况。结果 共37例患者入组,其中CP组12例,DP组25例。两组在手术时间[（119.92±29.56）min vs（100.92±27.91）min,t=1.902,P=0.065]、术中失血量[（291.67±178.16）mL vs（330.00±277.26）mL,t=-0.436,P=0.666]）、住院时间[（14.5±4.3）d vs（13.24±4.9）d,t=0.759,P=0.451）等方面差异均无统计学意义。在术后并发症方面,两组胰瘘、出血、腹腔感染、胃排空障碍发生率均无统计学差异（P＞0.05）;在术后内发泌功能不全（新发糖尿病）（9.1% vs 28.6%,P=0.374）、外分泌功能不全（0 vs 14.3%,P=0.534）方面两组虽存在差异,但也无统计学意义。两组均无围手术期死亡病例,随访期内无复发病例。结论 与传统术式DP治疗胰颈部或近体部胰腺实性假乳头状瘤相比,CP手术未增加术后并发症发生率,且在一定程度上降低了发生外分泌功能不全的风险,选用适宜的残端处理方法可有效控制CP手术后的胰瘘发生率。     

腹腔镜胰腺中段切除术

相比胰十二指肠切除术(PD)和远端胰腺切除术(DP),胰腺中段切除术(CP)适用于胰颈体部良性或低度恶性肿瘤,保留更多的胰腺内外分泌功能。随着微创外科理念的推广和技术成熟,腹腔镜胰腺中段切除术得到了愈来愈多的应用。在获得清晰手术视野,方便精细操作的同时,对术者也提出了更高的技术要求。本中心近期成功完成一例特殊腹腔镜胰腺手术,术前拟行腹腔镜胰腺中段切除术,由于胰管细小,无法定位,转而施行保留脾血管的远端胰腺切除术。我们的经验显示,熟练掌握多种胰腺术式对安全开展腹腔镜胰腺手术尤为重要。     

胰腺良性与交界性肿瘤:胰腺中段切除术与胰体尾切除术的临床疗效对比分析

目的分析胰腺中段切除术(CP)与胰体尾切除术(DP)在治疗胰腺良性与交界性肿瘤中的临床疗效差异。方法采用回顾性描述性研究方法,收集分析我院39例CP与52例DP的病例。观察病人的基本临床特征与术中情况、术后并发症和随访情况。结果 CP组的手术时间为(220. 96±90. 69)分钟,术后进食时间为(4. 29±1. 05)天; DP组手术时间为(275. 52±88. 78)分钟,术后进食时间为(5. 28±2. 22)天,两组比较差异具有统计学意义(P 0. 05)。胰瘘(B+C)、延迟性胃排空障碍、二次手术和死亡率等严重并发症中,两组比较未出现显著差异(P 0. 05)。与DP组相比,CP组病人在内、外分泌胰腺功能的保存中占明显优势,差异具有统计学意义(P 0. 05)。结论对于位于胰腺颈体部良性肿瘤和低度恶性肿瘤,CP是一种有效的治疗方法。相较于DP,行CP病人能够更好的从术后胰腺的内、外分泌功能保留中获益。     

中段胰腺切除术19例临床分析

背景与目的:胰十二指肠切除术(PD)和胰体尾切除术(DP)被认为是治疗胰腺肿瘤的标准术式.然而,它们应用于治疗良性或低度恶性肿瘤时可能导致的胰腺内外分泌功能不足需引起重视.本研究旨在探讨中段胰腺切除术(CP)治疗胰颈部或近端体部良性或低度恶性肿瘤的临床疗效.方法:回顾性分析南昌大学第一附属医院2009年6月—2020年...     

腹腔镜胰腺中段切除术的手术配合

胰腺中段切除即中央或中间胰腺切除术,是针对胰腺颈部或体部等中间部分肿瘤的一种术式.该手术能在切除病变组织的同时最大限度保留正常胰腺组织以及周围器官[1],从而保留胰腺的内、外分泌功能,且不改变消化道的生理连续性,患者术后的生活质量高.目前国内报道亦较少,且多采用开腹手术行胰腺中段切除术.我院2009年7月~2012年12月成功完成腹腔镜下胰腺中段切除术3例.现将手术配合报道如下：     

中段胰腺切除术在胰腺颈部横断伤中的应用

正1957年GUILLEMIN等[1]首先为1例慢性胰腺炎行中段胰腺切除术(central pancreatectomy,CP)和Ω型空肠袢吻合术,1959年LETTON等[2]对2例胰体外伤患者进行了CP,1988年Fagniez等[3]将CP用于胰腺中段的良性肿瘤的治疗,近年来国内也广泛应用于胰腺头颈部良性及低度恶性肿瘤[4-7]的治疗中;2005年6月至2016年5月本院及外院会     

腹腔镜胆囊切除术后放置腹腔引流随机对照试验的Meta分析

目的:系统评价腹腔镜胆囊切除术后腹腔内引流的有效性。方法:系统检索PubMed、Embase、Web of Science、Cochrane对照试验中心登记册及Cochrane图书馆(2018年11期)、CBM、CNKI、VIP等数据库。系统评价根据PRISMA指南进行,并采用固定与随机效应模型进行Meta分析。结果:共22项研究涉及3 866例患者的RCTs(其中引流组2 003例,非引流组1 863例)纳入研究。Meta分析结果显示,两组腹腔内液体发生率[RR=1.26,95%CI(0.92,1.72),P=0.16]、术后死亡率[RR=0.44,95%CI(0.04,4.72),P=0.50]差异无统计学意义。术后放置腹腔引流未能降低恶心或/和呕吐的总体发生率[RR=1.16,95%CI(0.95,1.42),P=0.15]、肩部疼痛发生率[RR=0.93,95%CI(0.71,1.23),P=0.62]。引流组具有更高的疼痛评分(通过视觉模拟评分测量)[MD=1.00,95%CI(0.58,1.42),P<0.00001],更长的手术时间[MD=6.07,95%CI(2.07,10.08),P=0.003]、术后住院时间[MD=0.73,95%CI(0.29,1.17),P=0.001]。切口感染与放置腹腔引流无关[RR=1.61,95%CI(0.97,2.69),P=0.07]。结论:腹腔镜胆囊切除术术毕放置引流管并无明显优势,腹腔引流的常规使用似乎具有不利的临床结果,对于这种措施应重新考虑。     

胰腺中段切除术

胰腺颈部和/或体部的良性或低度恶性肿瘤行单纯肿瘤摘除术成功率很低,传统的手术方式是扩大的远端胰腺切除术。尽管胰腺切除术效果确切,但由于此种术式会过多的切除大量的正常胰腺组织和脾脏,术后易引起胰腺内、外分泌功能不足和脾功能丧失,并发糖尿病、消化不良、     

胰腺远端切除术胰腺残端处理方法进展

随着手术方法的不断完善和手术技术的不断改进,胰腺远端切除术(distal pancreatectomy,DP)并发症发生率有了明显的降低,DP已成为治疗胰腺肿瘤、慢性胰腺炎、胰腺创伤的一种常用手术方式[1]。Billroth在1884年完成了第1例DP,并定义肠系膜上血管以左的胰腺切除为远端胰腺切除。虽然DP并发症发生率与胰腺其他部位切除术相比较     

胰腺中段切除术在胰腺疾病中应用(附17例报告)

目的 探讨胰腺中段切除术在治疗胰腺颈体部疾病的可行性及临床应用价值.方法 回顾分析西安交通大学第一附属医院2006年6月～2012年3月17例胰腺颈体部疾病患者实施胰腺中段切除术的临床资料,胰岛细胞瘤4例(2例为无功能性),黏液性囊腺瘤4例,浆液性囊腺瘤3例,实性假乳头状瘤3例,非侵袭性胰管内乳头状粘液癌2例(病理科已核实),外伤胰腺颈体部横断伤1例.结果 17例均行胰腺中段切除,胰体空肠Roux-en-Y吻合14例,胰头、胰体空肠双吻合3例,术后胰瘘5例(29.4％),出血2例(11.8％),经非手术治疗后痊愈.随访时间5个月-2年,1例因腹腔转移多器官衰竭术后5个月死亡;1例术后8个月因心脑血管疾病死亡;其余均存活,且随访期血糖监测正常,无其它并发症.结论 对于胰腺颈体部良性或低度恶性肿瘤,胰腺中段切除术是一种比较理想的手术方式,该术式能最大程度保留胰腺组织,维持胰腺的内、外分泌功能,维持上消化道连续性,可获得满意的治疗效果.     

Clinical outcome of laparoscopic distal pancreatectomy

Background  Few studies have compared laparoscopic distal pancreatectomy (Lap-DP) and open distal pancreatectomy (open-DP). The aim of this study was to evaluate the clinical outcome of Lap-DP and compare it to that of open-DP. Methods  A total of 37 patients who underwent distal pancreatectomy (Lap-DP, 21 patients; open-DP, 16 patients) between January 2000 and March 2007 were enrolled in this study. Prior to January 2004, open-DP was the standard procedure for patients with a lesion in the distal pancreas without invasive ductal cancer; thereafter, Lap-DP was also an approved procedure. All 16 open-DP procedures were performed prior to January 2004. Results  The operating times for the Lap-DP and open-DP patients were 308.4 ± 124.6 and 281.5 ± 83.3 min, respectively, and these were not significantly different (P = 0.4635). Blood loss for the Lap-DP group (249.0 ± 239.8 ml) was significantly smaller than that for the open-DP group (714.1 ± 650.4 ml) (P = 0.0055), and none of the patients in the Lap-DP group received transfusions. The frequency of complications for the Lap-DP and open-DP groups was 0 and 18.8%, respectively, which is not significantly different (P = 0.0784). The average hospital stay for the Lap-DP group was significantly shorter than that for the open-DP group (10.0 ± 2.6 vs. 25.8 ± 8.8 days; P < 0.0001). Conclusion  In pancreatic diseases, other than invasive ductal cancer, arising in the distal pancreas, Lap-DP might be a more feasible and safer than open-DP.     

中段胰腺切除术

Medial pancreatectomy has been gradually used in the treatment of benign tumors in neck and body of pancreas since less removal of the pancreas and the retainment of the duodenum,spleen and functional pancreas,it is less harmful to the endocrine and exocrine function of the patients.Seventeen patients received medial pancreatectomy for benign tumors in neck and body of the pancreas in the China-Japan Union Hospital of Jilin University from November 2005 to December 2010.Fifteen patients received the closure of broken ends of pancreatic head,pancreaticojejunostomy,and the other 2 received pancreaticojejunostomy.No perioperative death was found.All the patients were followed up for 2 to 45 months,and no death was recorded.No patient got new-onset diabetes and pancreatic pseudocyst,and their tumors were not relapsed.Now the retrospective analysis was carried out to this group of patients and to further regulate the surgical operation of the medial pancreatectomy.     

中段胰腺切除术

中段胰腺切除术因切除的胰腺组织少,保留了十二指肠、脾脏和有功能的胰腺,对患者内外分泌功能影响较小,近年来逐渐被应用于胰腺颈体部良性肿瘤的治疗。本文回顾性分析2005年11月至2010年12月我院接受中段胰腺切除术的17例胰腺颈体部良性肿瘤患者的临床资料,探讨中段胰腺切除术的技术要点。     

Clinical outcomes compared between laparoscopic and open distal pancreatectomy

Background Laparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy. Methods From February 1995 to March 2006, 31 patients underwent laparoscopic distal pancreatectomy, and 167 patients underwent open distal pancreatectomy at Seoul National University Hospital and Bundang Seoul National University Hospital. A case–control design was used with 2:1 matching to compare laparoscopic surgery with open surgery. Among 167 patients who underwent open distal pancreatectomy, 62 patients whose age, gender, and pathology were similar to those of patients who underwent laparoscopic surgery were selected for this study. The operation time, intraoperative transfusion requirements, duration of postoperative hospitalization, complications, mortality, recurrence, and hospital charges were analyzed. Results There were no significant differences in operation time, rate of intraoperative transfusions, complications, recurrence, or mortality between the two groups. Laparoscopic distal pancreatectomy was associated with a statistically significant shorter hospital stay (11.5 days vs 13.5 days; p = 0.049), but with more expensive hospital charges than open distal pancreatectomy (p < 0.01). Conclusion Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.     

Central pancreatectomy revisited

Central pancreatectomy is a surgical procedure that removes the middle segment of the pancreas and preserves the distal pancreas and spleen. This limited resection has the advantage of conserving normal, uninvolved pancreatic parenchyma, thus reducing the possibility of postoperative exocrine and endocrine dysfunction. While the incidence of postoperative endocrine insufficiency may be as low as 4%, procedural morbidity, specifically pancreatic fistula, appears to exceed the published rates for standard resections (i.e., distal/subtotal pancreatectomy or pancreaticoduodenectomy). We have reviewed our prospective pancreatic cancer database to determine the utilization of central pancreatectomy in a major cancer center with expertise in pancreatic surgery. We identified only 10 cases of central pancreatectomy over the past 13 years. Six (60%) had postoperative complications including three cases (30%) of pancreatic fistula. No patients died as a result of the procedure. At a median follow-up of 13.6 months (mean, 25.2 months), only one patient had mild endocrine insufficiency and no patients had clinically significant exocrine dysfunction. The associated morbidity of central pancreatectomy may outweigh any potential benefit in long-term pancreatic secretory function. We suggest that such a procedure be used selectively, where preservation of the pancreas appears essential.     

Case-control comparison of laparoscopic versus open distal pancreatectomy

Laparoscopic distal pancreatectomy is becoming an increasingly used modality in the surgical treatment of pancreatic disease. The assumption is that this will lead to shorter hospitalization and faster recovery. However, actual comparative data between open and laparoscopic distal pancreatectomy is lacking. The purpose of this study is to compare these surgical procedures. All patients who underwent either laparoscopic or open distal pancreatectomy/splenectomy were reviewed. Fifteen patients underwent laparoscopic resection, whereas 41 underwent an open resection. The 15 laparoscopic patients were matched to 15 open patients for age, gender, and pancreatic pathology. Data gathered included length of stay, pancreatic leak, postoperative complications, and return to normal activity. Of the 15 laparoscopic patients, three were converted to open operations. Laparoscopic patients had a median length of stay of 5 days (range, 3–9) compared with 8 days (range, 6–23) for the open patients (P = 0.02). The pancreatic leak rate was 13% in each group. Overall postoperative complication rate was 20% in the laparoscopic group compared with 27% in the open group. Laparoscopic patients reported a return to normal activity in 3 weeks (range, 2–7) compared with 6 weeks (range, 4–10) for open patients (P =0.03). Laparoscopic distal pancreatectomy/splenectomy does lead to shorter hospital stay and faster return to normal activity. Pancreatic leak rate and overall complication rate appear similar. Presented at the 2005 American Hepato-Pancreato-Biliary Association Congress, Hollywood, Florida, April 14–17, 2005 (poster presentation).     

腹腔镜胰体尾切除术的应用体会及技术改进

目的探讨腹腔镜胰体尾切除术的安全性、疗效和手术操作技巧。方法回顾性分析我院从2013年2月到2014年5月行腹腔镜胰体尾切除术的14例临床病例资料,对腹腔镜胰体尾切除术的安全性、近期疗效和手术操作要点分析总结。结果 14例均顺利完成腹腔镜手术,其中7例行保留脾脏的胰体尾切除术,7例联合脾脏切除,无手术中转,平均手术时间(172.25±39.41)min,平均术中出血(185.0±135.25)ml,平均术后禁食时间为(3.6±1.2)d,术后疼痛指数均在3分以下,平均术后住院时间(6.81±4.62)d。术后2例出现胰瘘(14.3%),其中1例合并腹腔内出血,再手术治愈,1例延迟拔管痊愈,无死亡病例,术后病理中,6例为粘液性囊腺瘤,5例胰腺神经内分泌肿瘤(其中2例为胰岛素瘤),1例实性假乳头状肿瘤和2例胰腺癌。结论腹腔镜胰体尾切除术在临床应用中是安全可行的,具有微创和快速康复的优势,起初开展该技术需选择合适的病例,且需要建立固定的腔镜操作团队,方能获得满意的疗效。     

Laparoscopic central pancreatectomy

BACKGROUND: The role of mini-invasive surgery in pancreatic surgery is still being debated. Indications and results are still controversial. Only a few centers in the world report on laparoscopic pancreatic resections. With the aim of improving the use of minimally invasive surgery, we have devised a novel laparoscopic procedure for surgical treatment of neuroendocrine tumor of the neck of the pancreas. METHODS: A central laparoscopic pancreatic resection was successfully performed. The pancreatic resection was performed using the harmonic scalpel. The duct was isolated and transected. The proximal duct stump was closed by an endoscopic stitch. The pancreaticojejunostomy was intracorporeally performed using a Roux-en-Y loop. RESULTS: Histologic findings showed a well differentiated neuroendocrine tumor. Operating time was 330 minutes and blood loss 300 mL. The postoperative course was uneventful. CONCLUSIONS: Laparoscopic central pancreatectomy is a feasible and safe procedure. The minimally invasive approach ensures an adequate treatment despite requiring the expertise of highly skilled laparoscopic surgeons.