保留十二指肠的胰头近全切除术治疗胰头部良性肿瘤

目的:探讨保留十二指肠的胰头近全切除术治疗胰头部良性肿瘤的价值。
方法:回顾性分析2004年1月—2009年12月4例施行保留十二指肠的胰头近全切除术患者的临床资料，均保留了胃肠道的完整性、肝外胆道、胆囊和Oddi括约肌的功能，仅在壶腹周围和胆管后方保留有少量胰腺组织。
结果:病理证实1例为导管内乳头状黏液瘤，1例为内分泌肿瘤，2例为实性假乳头状瘤。术后2例发生胰瘘，经过非手术治疗治愈。围手术期无死亡。随访8~20个月，均未发现复发征象。
结论:对于胰头部良性肿瘤，特别是摘除困难的，保留十二指肠的胰头近全切除术是合理的选择。

Duodenum-preserving near-total pancreatic head resection for benign tumors of the pancreatic head

Objective:To explore the value of duodenum-preserving near-total pancreatic head resection (DPNTPHR) without segmental duodenectomy for treating benign benign tumor of pancreatic head (BTPH).
Methods:The clinical data of 4 patients with BTPH, treated by DPNTPHR from January 2004 to December 2009, were retrospectively analyzed. The operation carried out was near total resection of pancreatic head while preserving the integrity of gastrointestinal tract, extrahepatic bile duct, gallbladder and the sphincter of Oddi. A small amount of pancreatic tissue was left intact around the papilla of Vater and behind the bile duct.
Results: Histology confirmed one patient had intraductal papillary mucinous neoplasm, one endocrine tumor and two solid pseudopapillary tumors. No mortality occurred in the perioperative period. Pancreatic leakage occurred in two cases and was treated successfully with conservative method. For 8-20 months Follow-up, all the 4 patients are no sign of recurrence.
Conclusions:Duodenum-preserving near-total pancreatic head resection is a proper option for benign tumors in the head of pancreas, especially when pancreatic enucleation is difficult.