胰尾增宽:一种少见的胰腺变异

目的 提高对胰尾增宽的认识水平.方法 遴选过去10年间28例胰尾增宽病例CT、MRI资料,复习文献,提出其诊断和鉴别要点.结果 ①胰尾增宽(n=24):胰尾最大前后径≥3.0 cm,明显超过最大高径和胰体前后径;②胰尾分叉(n=4):横断面像上,3例脾静脉穿行于增宽的胰尾内,1例重复畸形者,分又的胰尾内有独立的胰管.结...     

胰十二指肠切除术中常见血管变异及应对策略

胰十二指肠切除术是胰头及壶腹周围肿瘤的标准术式,也是腹部外科最复杂和危险的手术.至今,胰十二指肠切除术的术后并发症发生率仍明显高于其他消化外科手术,术后并发症发生率为30％～50％,术后死亡率为1％～5％[1-2].如何降低术后胰漏、出血、腹腔感染、胆漏、胃排空延迟等并发症的发生一直是外科医师努力改进的方向.同时,高质...     

预防胰十二指肠切除术后胰瘘的对策

近些年 ,对胰腺和壶腹周围恶性和良性肿瘤病人行胰十二指肠切除术(ＰＤ)增多并认为是一种安全手术。虽然ＰＤ术后死亡率不超过 2 % ,但术后并发症率仍高达 2 7%～ 5 0 %。ＰＤ术后3大常见的并发症是延迟胃排空、胰瘘、伤口感染或脓毒症。胰瘘仍然是ＰＤ并发症和导致死亡的主要原因 ,其发生率为 5 %～ 2 5 % ,胰瘘致死率为2 0 %～ 5 0 %。近几年几个大宗研究表明 ,手术死亡率平均为 6 0 % (0 %～8 9% ) ,术后胰瘘 (或漏 )率为 13 5 % ,而胰瘘引起 2 5 %的病人死亡〔6〕。新近来自ＰＤ高手术量治疗中心的报道 ,1990年～ 1996年施行的 6 5 0例…     

微创与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤效果Meta分析

目的 探讨微创下与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤的安全性和有效性,并分析病人的预后。方法 潍坊医学院附属医院通过对Embase、Pub Med、Cochrane Library、Web of Science、维普数据库、CNKI和万方数据库的检索,确定所有关于比较微创与开放胰十二指肠切除术治疗胰腺或壶腹周围肿瘤的随机对照试验。对文章的相关数据进行提取,主要结果是90 d病死率、严重术后并发生症、再手术率、住院时长;次要结果包括术中失血量,手术时间,术后出血,术后胃排空延迟,术后胰漏、胆漏,入住ICU时长,再次入院率;肿瘤学结局指标包括R0切除率、淋巴结清扫数。采用Rev Man 5.4软件进行数据分析。结果 一共检索到文献9226篇,经过剔除非随机对照研究,按照纳入排除标准共筛选出4项随机对照研究,共738例病人。Meta分析结果显示腹腔镜下胰十二指肠切除术（LPD）比开放性胰十二指肠切除术（OPD）的失血量低（MD:-128.59 m L,95%CI-173.28～-83.89,P<0.00001）,住院时间短（RR=-1.63;95%CI-2.71～-0.54;P...     

国人胰背动脉、胰十二指肠下动脉的CT解剖观察

背景与目的:胰腺切除手术复杂,术中意外出血风险较大.术前精准评估胰腺周围血管起源、走行有助于降低术中出血风险.目前,尚缺乏对国人胰周血管解剖的系统性研究.本研究目的在于探明国人胰背动脉(DPA)及胰十二指肠下动脉(IPDA)的解剖学特点,并探索最佳CT图像后处理方式.方法:收集2016年12月-2017年6月行腹部增强...     

胰十二指肠切除术治疗胰头和壶腹周围癌

胰十二指肠切除术治疗胰头和壶腹周围癌上海市金山县中心医院外科（２０１５００）胡军，金庆丰胰十二指肠切除术是治疗可切除胰头和壶腹周围癌的首选手术方式。近年来一些文献报告手术并发症和死亡率有所降低，但仍偏高。我们自１９７７年１月～１９９１年１２月，对３７...     

三维可视化技术在胰腺占位患者胰周血管解剖变异分析中的应用

目的:探讨三维可视化技术在胰腺占位患者胰周血管解剖变异分析中的应用价值。方法:回顾性分析2018年6月至2019年12月在皖南医学院弋矶山医院、中国科学技术大学附属第一医院、安徽医科大学第一附属医院、安徽医科大学第二附属医院、蚌埠医学院第一附属医院、阜阳市人民医院诊断为胰腺占位并完成上腹部增强CT扫描的98例患者资料。...     

胰十二指肠切除术后胰瘘发生的相关因素分析

目的 探讨胰十二指肠切除术后胰瘘发生的危险因素.方法 回顾性分析2000年5月至2010年5月昆明医学院第二附属医院收治的186例行胰十二指肠切除术患者的临床资料,根据术后是否发生胰瘘将患者分成胰瘘组(39例)和非胰瘘组(147例)进行队列研究.对围手术期可能与胰瘘发生相关的多种因素进行分析,筛选胰十二指肠切除术后胰瘘发生的危险因素.单因素分析采用x2检验或Fisher确切概率法,多因素分析采用Logistic回归模型.结果 186例患者中39例发生胰瘘,其中A级26例、B级10例、C级3例.单因素分析结果显示:术前黄疸时间、术前6个月体质量下降、术前TBil、术前纠正后Alb、术后第3天Alb、胰腺残端游离长度、胰管直径、胰腺质地、腹腔引流管拔出时间是发生胰瘘的影响因素(x2=34.990,20.480,8.212,10.890,13.561,11.505,13.820,4.539,36.590,P＜0.05).多因素分析结果显示:术前黄疸时间＞8周、术前6个月体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软、腹腔引流管拔出时间＞5d是发生胰瘘的独立危险因素(OR=2.229,3.383,1.437,1.273,11.939,P＜0.05).结论 术前黄疸时间＞8周、术前6个月内体质量下降≥10％、胰管直径＜3 mm、胰腺质地柔软和腹腔引流管拔出时间＞5d将增加患者胰十二指肠切除术后胰瘘的发生率.     

环状胰腺合并胰腺结石行胰头切除胰十二指肠捆绑吻合术一例

患者女,13岁。因反复上腹痛伴发热4年入院。患者出生7d时曾因呕吐胃内容及黄绿色液体在当地医院住院。 40 d时以“肠梗阻”行“剖腹探查,胃空肠吻合术”。1个月前在外院诊断“胰管结石”行抗炎、胰管镜取石失败。查体:一般情况可,消瘦。巩膜无黄染,腹平软,右上腹见一长10 cm 手术瘢痕。血象及血清胆红素、淀粉酶正常。B超示胰头部结石,CT示胰头部结石、环状胰腺可能。行剖腹探查术,术中见腹腔内广泛粘连,分离后见环状胰腺包绕十二指肠降部,胰头部质地硬,有沙样感伴结石,胃空肠侧侧吻合口通畅     

Ventral pancreatectomy: Resection of the ventral segment of the pancreas

Based on embryologic evidence that the pancreas is formed by the fusion of the ventral and dorsal pancreatic anlagen, a study was undertaken to determine whether either of these two pancreatic segments could be resected separately. As it was concluded that this was possible, the author used this surgical approach to excise the dorsal pancreatic head in a patient with pancreatic divisum. The operative procedures of this ventral pancreatectomy are discussed.     

Ventral pancreatic resection for adenoma and low-grade malignancies of the head of the pancreas

The head of the pancreas can be anatomically divided into two sections, one drained by the duct of the Santorini system, and the other drained by the ventral pancreatic duct. This study was undertaken to determine whether independent resection of the ventral pancreas drained by the ventral pancreatic duct could be performed safely and effectively, by employing the following method in four patients. First, the duodenum and pancreas were sufficiently separated preserving the mesoduodenum and the posterior pancreaticoduodenal artery. Next, the main pancreatic duct was divided at the papillary portion, and sectioned at its junction with the duct of Santorini, ensuring preservation of the intrapancreatic bile duct. After the ventral pancreas had been detached from the glistening intrapancreatic bile duct, the ventral pancreas was connected with the dorsal pancreas by only the pancreatic parenchyma. The ventral pancreatic resection was completed following the incision of this border. A pancreatic fistula developed in one patient postoperatively, but this healed within 30 days. The hospital stay after surgery ranged from 35 to 58 days, and a good quality of life was maintained in all four patients. Thus, we conclude that ventral pancreatic resection can be safely performed and is especially valuable for treating the increasingly frequent adenomas and borderline malignancies in the main pancreatic duct system of the head of the pancreas.     

Successful preoperative diagnosis of heterotopic pancreas in the duodenum

IntroductionHeterotopic pancreas (HP) is a relatively rare entity occurring in approximately 5% of the general population. It most commonly presents as an asymptomatic mass incidentally picked up on unrelated scans. HP most commonly occurs intra-abdominally, but has been known to occur in extra-abdominal sites such as the lung and brain. It is widely considered to bear little to no malignant potential. Difficulty and ambiguity in the diagnosis of HP commonly results in interventional dilemma and delay.Presentation of caseWe present a case of uncomplicated HP that was ultimately treated conservatively.DiscussionA literature review is made of the typical workup in a patient with suspected HP, and the characteristic radiological and endoscopic findings commonly used for diagnosis of this rare condition. A succinct summary of management guidelines for HP is reviewed.ConclusionHP is most commonly an incidental finding. Ambiguity surrounding its diagnosis commonly gives rise to interventional dilemma and delay. The gold standard for diagnosis remains that of EUS and FNA with histological confirmation. This report has been written in concordance with the SCARE criteria Agha et al. [1].     

异位胰腺的诊断和治疗(附27例报告)

目的　探讨异位胰腺的临床特点、诊断及治疗方法。方法　回顾性分析我院 1975～2 0 0 3年收治的异位胰腺 2 7例临床资料。结果　年龄在 13～ 6 7岁之间 ,平均年龄 37.4岁。有临床症状者 18例。 4例行胃镜下电凝切除 ;2 3例剖腹手术切除 ,其中 3例术前确诊。异位胰腺分布部位 :胃9例 ,十二指肠 3例 ,空回肠 14例 ,胆囊 1例。结论　异位胰腺无特异临床症状 ,术前确诊困难。对出现临床症状者 ,手术切除是首选治疗方法。     

Benign schwannoma of the pancreas

Reported cases of intrapancreatic schwannomas have recently increased in the literature. However, none of these cases were diagnosed clearly as schwannoma preoperatively. We herein describe the clinicopathologic findings of a solitary benign schwannoma occurring in the head of the pancreas. Additionally, the differential diagnosis versus other cystic- and solid-appearing pancreatic masses is briefly discussed.     

肠系膜异位胰腺的临床特点和处理

目的 总结分析肠系膜异位胰腺的临床特点以提高诊治水平。方法 对2008年3月至2018年5月火箭军总医院肝胆外科收治的7例肠系膜异位胰腺病例的临床资料进行回顾性分析。结果 本组4例有腹部不适症状,2例有胰腺炎症状,1例体检偶然发现。术前影像学检查仅2例CT提示“异位胰腺”,其余均考虑为小肠占位病变。全部病例均行腹腔镜手术治疗,术中探查发现肿块为长叶状,淡黄或灰白色,质地韧,有完整的包膜,长径3.5～8.5 cm,平均（5.0±2.5）cm。肿块位置：位于近端空肠Treitz韧带处3例,远端空肠系膜处2例,回肠系膜处2例。其中位于肠系膜间5例,肠系膜血管根部2例。2例与小肠肠壁部分相连接。手术时间1.5～3 h,平均（1.8±2.4）h。术后均未发生明显并发症,随访3～12个月,无复发及死亡。结论 肠系膜异位胰腺缺乏特征性的临床表现的和有效的检查手段,易与其他占位性病变混淆。手术治疗是安全有效的治疗手段,个体化制定治疗方案尤为重要。     

胰腺实性假乳头状瘤的诊治分析

目的 回顾18例胰腺实性假乳头状瘤(SPPT)的临床病理特点及治疗,以求建立最佳诊断方法及手术治疗方案.方法 回顾近12年18例SPPT患者的术前、手术、术后资料,包括年龄、性别、症状体征、实验室检查、手术、病理及复发和预后情况.结果 18例患者中女性16例,男性2例,平均年龄30.9岁.所有患者均没有特异的实验室检查阳性结果,肿瘤标记物均基本正常.17例患者均获得手术切除肿瘤.平均术后住院日10.7 d,(随访时间3～113个月).切除患者均无复发.术前影像学中肿瘤的大小、包膜、囊实性比例同胰腺实性假乳头状瘤的良恶性无明显关系.结论 该研究证实SPPT是多发于青年女性的少见肿瘤.手术切除是治愈该疾病的治疗方式.     

Management of cystic tumours of the pancreas

BACKGROUND: Cystic tumours of the pancreas account for 5% of pancreatic neoplasms and are frequently misdiagnosed as pancreatic pseudocysts. The authors' experience of managing these tumours is presented here, highlighting the clinical presentation, diagnostic difficulties and operative treatment. METHODS: This is a retrospective study of all patients diagnosed to have cystic tumours of the pancreas treated at The Mater Hospital, during a 5-year period from 1997 to 2002. Literature was reviewed and guidelines for the management of these tumours have been outlined. RESULTS: Seven patients with cystic pancreatic tumours were treated over this time-period. All patients were women with a median age of 40. Two of these patients were initially diagnosed as having pseudocysts and were treated elsewhere by cystgastrostomy. The tumour was resected in all patients. All but one was benign. At follow up, ranging from 13 to 66 months, all patients were alive and well. CONCLUSIONS: Cystic tumours of the pancreas are uncommon and generally slow growing. It is important not to assume that a cystic lesion in the pancreas, especially in middle-aged women, is a pseudocyst. Satisfactory surgical resection may be possible even after previous operative procedures on the pancreas. Prognosis after resection remains good.     

异位胰腺的外科诊治(附21例报告)

目的探讨异位胰腺的临床诊断与外科处理要点,提高异位胰腺的外科诊治水平。方法回顾性分析1996年1月至2006年2月间我院收治的21例经病理证实的异位胰腺病例资料,对其临床诊断及外科处理进行临床分析,并结合文献讨论。结果21例异位胰腺异位于十二指肠的9例,胃7例,空肠3例,肠系膜2例,均为单发。根据临床表现分型,梗阻型4例,出血型1例,溃疡型1例,肿瘤型3例,憩室型1例,隐匿型11例。分别行胃部分切除术、肠切除术、胰十二指肠切除术、肿块切除。手术后,由异位胰腺引起的临床症状均缓解。结论异位胰腺临床表现复杂多样,并发症多,常易被误诊和漏诊,当症状明显时,应积极手术治疗。