胰头癌切除术式的选择

胰头癌是十分常见的胰腺恶性肿瘤，其发病率在全球均有明显的逐年增加的趋势。美国胰腺癌的发生据估计每年有24000个新病例，胰头癌约占2／3以上。本病早期诊断困难，预后极为恶劣。手术切除率约15％，术后5年生存率为7％～10％。由于胰头十二指肠切除手术死亡率与并发症过高的缘故，致使胰头癌的外科治疗一度陷入困境。近年随着影像诊断技术与围手术期监测的进展，胰头十二指肠切除术的并发症、死亡率已有所降低，在有大量经验的外科中心其死亡率已降至3％以下。美国JohnsHopkins医院更有大宗手术病例连续无死亡的报告。手术切除已被公认…     

胰头癌姑息性手术探讨

胰头癌姑息性手术探讨浙江省嘉善县第一医院（３１４１００）孙大墉胰腺癌切除率至近年仅达２０％，大量病人只能作姑息性手术，而这类手术亦有一定手术死亡率和并发症。我院自１９８５年１月至１９９４年１２月共收治胰头癌手术病人３１例，其中切除４例，姑息性转流术或...     

胰头癌的生物学特性及术式选择

胰腺癌的发病率逐渐增加 ,且死亡率居高不下 ,已成为危及人类生命的主要恶性肿瘤之一。由于胰腺位置深在 ,肿瘤早期缺乏特异性症状 ,难以早期诊断。目前 ,我国到医院就诊的胰腺癌患者多为进展期肿瘤。据中华医学会胰腺外科学组对1990～ 1995年全国 2 0家医院的统计资料 ,5 9.6%的患者就诊时肿瘤大于 5ｃｍ ,70 %以上的肿瘤伴有胰周组织、器官的浸润、转移。根治性手术切除率为 18.6%。其中 ,胰头癌占全部肿瘤的 80 %以上。多种因素影响着胰头癌患者的术后疗效 ,这些因素又多与肿瘤特有的生物学特性相关。了解胰头癌的生物学特性及复发、转移…     

胰头癌的术式选择

胰腺癌的发病率呈上升趋势,近30年来发病率上升3～7倍。胰腺癌可发生于胰腺的任何部位,胰头癌约占2／3。我院360例胰腺癌中胰头癌占75％。中国抗癌协会胰腺癌专业委员会报道胰腺癌2340例,胰头癌占70％。郑树森等2003年报道胰腺癌216例,胰头癌占70．2％。由于胰腺癌多发生于胰头部,临床研究亦多为胰头癌的诊断与治疗。     

胰头癌的外科治疗

目的:探讨胰头癌的外科治疗.方法:因术前临床诊断胰头癌施行胰十二指肠切除术265例,其中行常规胰十二指肠切除术(WhiPPle)152例,保留幽门型胰十二指肠切除术(PPPD)75例,包括切除一段血管的胰十二指肠切除术19例,经再次手术行胰十二指肠切除术17例,全胰切除术2例.术前经B超、CT、选择性ERCP、穿刺细胞学检查,确诊232例(87.5%).术后经病理证实:胰头癌132例,壶腹癌77例,胆总管远端癌22例,十二指肠癌16例,转移癌1例和良性病变17例(慢性胰腺炎14例和良性肿瘤3例).结果:术后发生并发症118例(47.6%),住院死亡10例(4%).PPPD术后并发胃排空障碍较其它术式显著增高(P<0.01).结论:由非胰腺专业组医师施行的手术死亡率明显高于专业组医师(P<0.05),只要病例选择恰当,围手术期良好的处理,可以继续降低手术死亡率.     

早期胰头癌行保留幽门的胰十二指肠切除术

早期胰头癌行保留幽门的胰十二指肠切除术马学敏，刘世平，张健，林铁男我们自１９９２年１０月～１９９４年９月间作６例保留幽门的胰十二指肠切除术，现报告如下。１．临床资料：本组男５例、女１例；平均年龄５５岁。６例患者均因黄疸进行性加重入院。病程１５天～２个...     

148例胰头癌外科治疗分析

目的 总结提高胰头癌手术切除率，手术质量和治疗效果的经验。方法 以1990年为界，将病 列分为前期组（67例）和后期组（81例），分析两组病例的性别，年龄，临床表现，术中所见，手术切除率等。结果 两组病例均男性多于女性，高发年龄为50-70岁，主要症状均为上腹部胀痛不适，黄疸，食欲下降和消瘦，后期组胰十二指肠切除率明显高于前期组。结论 1，及时剖腹探查，适当放宽胰十二指肠切除术的指征，努力处理肿块与门静脉，肠系膜上静脉间的粘连或浸润是提高手术切除率的重要途径，2，彻底清扫区域淋巴结，完整切除勾突，减少胰瘘发生率是提高手术质量和远期效果的重要保证。     

胰头癌外科手术治疗效果的评价

自 1935年Ｗｈｉｐｐｌｅ成功施行胰十二指肠切除术之后 ,该手术就成了胰头癌外科治疗的标准手术。但是因手术并发症和死亡率高 ,患者远期生存率低而受到置疑 ,甚至有人认为应当采用非手术疗法代替手术治疗。 1973年Ｆｏｒｔｎｅｒ提出区域性胰腺切除术 ,1976年前后Ｂｒｏｏｋｓ、Ｍｏｏｓｓａ及Ｒｅｍｉｎｅ等倡导全胰切除术 ,一度形成胰腺癌外科治疗的高潮。不过该手术创伤大 ,手术疗效没有显著改善 ,并未被广泛接受。近年来由于影像学技术的发展 ,外科手术和麻醉技术的进步 ,以及围手术处理水平的提高 ,胰腺癌的手术死亡率开始下降。腹膜…     

Tailored resective pancreatic surgery for pediatric patients with chronic pancreatitis

Background

Surgical treatment for chronic pancreatitis (CP) in children comprises predominantly nonresective draining procedures. The purpose of this study was to identify indications, techniques, and results of organ-preserving resective pancreatic procedures for pediatric CP at our institution.

Patients and Methods

A retrospective chart review was performed of all children undergoing pancreatic surgery for CP over a period of 4 years.

Results

Overall, 6 pediatric patients (3 male, 3 female, ages 7-18 years) underwent a duodenum-preserving pancreatic head resection (3), a middle segmental pancreatic resection (2), or a distal pancreatectomy (1) for CP of different etiologies (idiopathic 2, posttraumatic 2, pancreas divisum 1, situs inversus 1). No mortality or major surgical complication occurred. Mean operative time was 294 min (207-412 min) and intraoperative blood loss was 541 mL (100-1300 mL). Postoperative hospital stay was 13 days (10-18 days). No endocrine or exocrine insufficiency occurred during follow up of 46 months (25-50 m), and pain control was improved in 5 of 6 patients.

Conclusions

Tailored organ-preserving resective pancreatic surgery can be performed with low morbidity and mortality in pediatric patients with CP and not responding to conservative treatment.     

Preoperative cardiac assessment of the candidate for major resective pancreatic surgery.

The risk of perioperative cardiac morbidity and mortality can be predicted based on clinical assessment and noninvasive testing for the detection of myocardial ischemia. Appropriate preoperative interventions in high-risk patients are indicated. Medical intervention with beta blockade is particularly effective.     

肾上腺偶发瘤的外科治疗选择

目的 探讨肾上腺偶发瘤的手术指征.方法 总结147例肾上腺偶发瘤患者资料,分析偶发瘤的手术指征,比较腹腔镜和开放性手术的适应证.147例患者中,恶性肿瘤19例(12.9%),平均直径(8.5±3.9)cm,≤4 cm者4例(21.1%),其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例;良性功能性肿瘤29例(19.7%),平均直径(4.1±2.1)cm,其中≥3 cm者22例(75.9%);19例良性嗜铬细胞瘤中24 h尿香草扁桃酸升高2例,5例醛固酮瘤中血钾稍低2例,5例亚临床库欣综合征腺瘤患者血皮质醇升高,均无明显内分泌异常症状;良性无功能性肿瘤99例(67.3%),其中肾上腺皮质腺瘤61例(61.6%).结果 147例均行手术治疗.腹腔镜下手术组102例,开放性手术组45例,2组肿瘤直径分别为(3.4±1.8)cm和(6.7±1.5)cm(P＜0,0001);手术并发症发生率分别为5.9%(6/102)和15.6%(7/45)(P=0.1103).腹腔镜中转开放手术5例(4.9%),主要见于黏连严重的恶性肿瘤或肿瘤直径＞6 cm者.结论 肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌.可疑恶性、有内分泌功能、直径≥3 cm的肾上腺偶发瘤应积极手术治疗.腹腔镜手术创伤小、恢复快,为手术首选;肿瘤直径＞6 cm、黏连严重、可疑恶性者应以开放性手术为主.     

Duodenum-preserving total pancreatic head resection for cystic neoplasm—a limited but cancer-preventive procedure

Background Cystic neoplastic lesions of the pancreas are found in up to 10% of all pancreatic lesions. A malignant transformation of cystic neoplasia is observed in intraductal papillary mucinous tumor (IPMN) lesions in 60% and in mucinous cystic tumor (MCN) lesions in up to 30%. For cystic neoplasia located monocentrically in the pancreatic head and that do not have an association with an invasive pancreatic cancer, the duodenum-preserving total head resection has been used in recent time as a limited surgical procedure. Patients An indication to duodenum-preserving total pancreatic head resection is considered for patients who do not have clinical signs of an advanced cancer in the lesion and who have main-duct IPMN and monocentric MCN lesions. In 104 patients with cystic neoplastic lesions in the Ulm series, 32% finally had a carcinoma in situ or an advanced pancreatic cancer. The application of a duodenum-preserving total pancreatic head resection in patients with asymptomatic cystic lesion is based on the size of the tumor and the tumor relation to the pancreatic ducts. For patients who have preoperatively clinical signs of malignancy, a Kausch–Whipple type of oncologic resection is recommended. Results Duodenum-preserving total pancreatic head resection is used in several modifications. The surgical procedure is a limited pancreatic head resection which necessitates segmental resection of the peripapillary duodenum. Hospital mortality is very low; in most published series it is 0%. The long-term outcome is determined by completeness of resection for both—benign and malignant—entities. Careful evaluation of the frozen section results has a pivotal role for intraoperative decision making. Conclusion A duodenum-preserving total pancreatic head resection is a limited surgical procedure for patients who suffer a local monocentric, cystic neoplastic lesion in the pancreatic head. Absence of an advanced pancreatic cancer and completeness of extirpation of the benign tumor determine the long-term outcome. In regards to the location of the lesion in the pancreatic head, several modifications have been applied with low hospital morbidity and mortality below 1%.     

保留十二指肠胰头切除术的适应证及术式选择:附22例报告

目的探讨保留十二指肠胰头切除术（DPPHR）的适应证及具体术式的选择指征。方法回顾性分析我中心2001年1月至2006年1月实施的22例DPPHR术患者的临床资料,其中黏液性囊腺瘤8例,黏液性囊腺癌2例,实性-假乳头状瘤4例,神经内分泌肿瘤2例,慢性胰腺炎4例（伴胰头肿块2例,伴多发结石2例）,淋巴上皮囊肿1例,浆液性囊腺瘤1例。探讨DPPHR术式的适应证、手术方式的选择及术后并发症的防治。结果患者手术死亡0例,术后发生胰瘘3例,胆瘘1例,腹腔感染1例,十二指肠瘘2例。结论DPPHR术保留了胃、十二指肠及胆道的连续性,手术安全性好,降低了手术创伤和切除范围,可作为胰头颈部良性和低度恶性肿块局限性切除的术式。     

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。