胰十二指肠切除术87例临床分析

目的　探讨胰十二指肠切除术指征 ,提高手术切除率及减少术后并发症的发生。方法　回顾性总结 1990～ 2 0 0 2年 8月间我院收治的 87例胰十二指肠切除术病例的临床资料 ,采用联合定性法和经十二指肠胰腺穿刺组织学检查提高诊断率。逆向胰腺切断 ,血管修补提高切除率。单层套入式胰十二指肠切除术胰肠重建。术前“减黄”等措施减少手术并发症。结果　 87例中 ,术后出现胰瘘 1例 ,胆瘘 2例 ,胃肠吻合口瘘 1例。住院期间死亡 3例。重度梗阻性黄疸术后并发症的发生率明显增高。结论　可能的诊断及合适的探查和适应证范围的扩大能提高手术切除率。术前“减黄”、单纯套入式胰肠吻合等正确手术操作 ,是降低术后并发症发生率的有效方法     

165例胰十二指肠切除患者临床与病理分析

目的　探讨影响胰十二指肠切除术对壶腹周围癌患者预后的因素。方法　 16 5例壶腹周围癌患者 ,其中壶腹癌 6 9例 ,远端胆管癌 32例 ,胰腺癌 4 8例 ,十二指肠癌 16例 ,均行胰十二指肠切除。保留幽门5 5例 ,不保留幽门 110例。结果　本组 30d病死率为 4 .8% ,住院期间病死率为 6 .7%。切缘无癌组织 135例 ,5年生存率 2 9% ;切缘有癌组织 30例 ,5年生存率 6 %。淋巴结无转移 85例 ,5年生存率 35 % ;淋巴结转移 80例 ,5年生存率 2 0 %。肿瘤直径 <3cm者生存时间长。结论　胰十二指肠切除术后患者预后与切缘是否干净、淋巴结是否转移及肿瘤大小有关。 5年生存率壶腹癌患者最高 ,胰腺癌最差。保留与不保留幽门患者预后相似。     

Determinants of surgical resection for pancreatic neuroendocrine tumors

Pancreatic neuroendocrine tumors (pNETs) include functioning and non‐functional tumors. Functioning tumors consist of tumors that produce a variety of hormones and their clinical effects. Therefore, determinants of resection of pNETs should be discussed for each group of tumors. Less than 10% of insulinomas are malignant, therefore more than 90% of the cases can be cured by surgical resection. Lymphadenectomy is generally not necessary in insulinoma operation. If preoperative localization of the insulinoma is completed, enucleation from the pancreatic body or tail, and distal pancreatectomy can be performed safely by laparoscopy. When preoperative localization of a sporadic insulinoma is not confirmed, surgical exploration is needed. Intraoperative localization of a tumor, intraoperative insulin sampling and frozen section are required. The crucial purpose of surgical resection is to control inappropriate insulin secretion by removing all insulinomas. Gastrinomas are usually located in the duodenum or pancreas, which secrete gastrin and cause Zollinger‐Ellison syndrome (ZES). Duodenal gastrinomas are usually small, therefore they are not seen on preoperative imaging studies or endoscopic ultrasound, and can be found only at surgery if a duodenotomy is performed. In addition, lymph node metastasis is found in 40–60% of cases. Therefore, the experienced surgeons should direct operation for gastrinomas. Surgical exploration with duodenotomy should be performed at a laparotomy. Other functioning pNETs can occur in the pancreas or in other locations. Curative resection is always recommended whenever possible after optimal symptomatic control of the clinical syndrome by medical treatment. Indications for surgery depend on clinical symptom control, tumor size, location, extent, malignancy and presence of metastasis. A lot of non‐functioning pNETs are found incidentally according to the quality improvement of imaging techniques. Localized, small, malignant non‐functioning pNETs should be operated on aggressively, while in possibly benign tumors smaller than 2 cm the surgical risk‐benefit ratio should be carefully weighted. Surgical liver resection is generally proposed in curative intent to all patients with operable metastases from G1 or G2 pNET. The benefits of surgical resection of liver metastases have been demonstrated in terms of overall survival and quality of life. Complete resection is associated with better long‐term survival.     

胰十二指肠切除术后出血的危险因素分析

目的:探讨胰十二指肠切除术(PD)后腹腔和消化道出血的危险因素。方法:回顾性分析2005年5月—2011年5月在新疆医科大学第一附属医院行PD手术的132例壶腹周围癌患者的临床资料。结果:132例患者中,术后(腹腔和消化道)出血27例(20.5%),其中术后消化道出血12例(9.1%),腹腔内出血6例(4.5%),腹腔兼消化道出血9例(6.8%)。单因素分析结果显示,术中出血量、术中输血量、术后腹腔感染、胰瘘、胆瘘及胰肠吻合口瘘与PD术后出血有关(均P<0.05);多因素分析结果表明,术中出血量≥500 mL(P<0.000,95%CI=6.900~103.775)、胰瘘(P=0.003,95%CI=2.319~55.717)及腹腔感染(P=0.043,95%CI=1.046~19.364)是PD术后出血的独立危险因素。结论:术中出血量≥500 mL,胰瘘,腹腔感染是胰十二指肠切除术后出血的独立危险因素。     

“悬吊式”胰管-空肠端侧连续缝合吻合在胰十二指肠切除术中的应用

目的 探讨“悬吊式”胰管-空肠端侧连续缝合吻合对胰十二指肠切除术后胰瘘发生的影响,探讨其实用性、安全性、有效性.方法 采用非随机临床对照研究,对165例施行胰十二指肠切除术的临床资料行对比分析,比较三种不同胰肠吻合方法对胰瘘及其他并发症发生率的影响.结果 总胰瘘发生率13.9％.端端或端侧套入式胰肠吻合组(A组)、端侧黏膜-黏膜胰管空肠吻合组(B组)和悬吊式胰管-空肠端侧连续缝合吻合组(C组)的胰瘘发生率分别是23.1％(12/52)、18.8％(9/48)和3.1％(2/65).C组在手术时间、术中出血及术后血浆管引流量上优于A、B两组(P＜0.05),A、B两组间差异无统计学意义(P＞0.05).其他并发症三组间差异无统计学意义(P＞0.05).结论 悬吊式胰管-空肠端侧连续吻合术能显著降低胰十二指肠切除术后的胰瘘发生率.该术式安全、实用、便捷,值得推广.     

胰十二指肠切除术后胃排空延迟发生及严重程度的危险因素分析

目的分析胰十二指肠切除术后胃排空延迟发生及病情严重程度的危险因素。方法回顾性分析208例在我院进行胰十二指肠切除术患者的临床资料。采用多因素Logistic回归分析进行危险因素分析。结果术后83例出现胃排空延迟,发生率为39.90%,其中A级31例(14.90%),B级27例(12.98%),C级25例(12.02%)。保留幽门、Child法重建消化道、术中出血量≥1000 mL、手术时间≥360 min、术后腹部并发症术后胃排空延迟的发生率更高(P<0.05),其中Child法、术中出血量、术后腹部并发症是胃排空延迟发生的独立危险因素(P<0.05)。术后年龄≥60岁、保留幽门、手术时间≥360 min、术后腹部并发症术后胃排空延迟病情更严重(P<0.05),其中年龄、术后腹部并发症是胃排空延迟病情严重程度的独立危险因素(P<0.05)。结论胰十二指肠切除术后胃排空延迟发生率高,采用改进型消化道重建方式、减少术中出血量和术后腹部并发症有助于降低发生率;高龄和合并术后腹部并发症的患者发生胃排空延迟的严重程度明显增加。     

胰十二指肠切除术后联合营养支持临床分析

目的：探讨肠内营养＋肠外营养（EN＋PN）支持对维持和改善手术创伤术后患者营养状态的效果。方法：选择胰十二指肠切除术后需行营养支持的16例患者，随机分PN组及EN＋PN组。两组营养支持均等热量、等氮量。营养支持前、手术后12d测血清白蛋白、胆固醇和胆红素含量。结果：①EN＋PN组白蛋白、血清胆固醇含量高于PN组，但无显著差异（P〉0．05）。@EN＋PN组血胆红素、胆汁酸比PN组明显改善（P〈0．05）。结论：与PN支持相比，EN＋PN可较早期有效地改善术后患者的营养状态。应根据术后患者的具体情况，合理早期应用EN。