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1.
胰十二指肠切除术的技术改进 总被引:1,自引:0,他引:1
目的 探讨改进胰十二指肠切除术,预防术后并发症,提高手术疗效的方法。方法 采用保留幽门、胰管空肠粘膜吻合+胰肠遮盖套入式吻合、胰管支撑外流充分切除胰钩突的术式,并观察其疗效。结果 全组未发生胰瘘及胰断面出血。保留幽门胰十二批肠切除术(PPPD)者有1例术后发生胃潴留,其余胃排空正常。结论 PPPD只要操作得当,可避免术后胃潴留。胰肠遮盖套入式吻合操作简便,可防止术后胰瘘、胰断面出血等并发症。 相似文献
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L. William Traverso 《Journal of hepato-biliary-pancreatic sciences》1994,1(4):329-334
The Whipple procedure has been improved by preservation of afunctioning pylorus. A functioning pylorus is important because marginal ulceration is avoided and, compared to the standard Whipple procedure with hemigastrectomy, more patients can gain weight postoperatively. The most common indications for this procedure are severe complication of chronic pancreatitis and periampullary tumors. In patients with pancreatic adenocarcinoma, the pylorus-preserving variety results in equal or better survival rates than those of the standard Whipple procedure with hemigastrectomy. Surgery alone is not sufficient to improve survival rates in patients with adenocarcinoma of the pancreas. Improved imaging modalities are required to diagnose the disease earlier. The most likely combination of treatment to prolong survival time is a combination of resection for cure in a patient with an early diagnosis plus an aggressive adjuvant chemoradiotherapy protocol. This protocol is most likely to be completed if a patient has preserved endocrine, exocrine, and digestive ability. A radical (R1) pylorus-preserving Whipple procedure would have the following advantages to result in the best survival rates — the patients can gain weight and thereby withstand the chemoradiotherapy protocol while, at the same time, the weakest aspect of the radical resection is addressed, i.e., the retroperitoneal margin of the pancreatic head. 相似文献
3.
手术治疗十二指肠肿瘤患者 12例 ,术前分别行B超、螺旋CT、钡剂造影、内镜检查 ;术中行常规冷冻病理切片检查 ;确诊良性肿瘤 8例 ,恶性 4例。除降部 3例恶性肿瘤行传统胰十二指肠切除术外 ,其余病例行十二指肠节段性切除。结果 :B超、钡剂造影、螺旋CT、内镜检出率分别为 5 / 7、81 8% ( 9/ 11)、8/ 9及 83 3 % ( 10 / 12 ) ;十二指肠节段切除手术平均时间 2 5h ( 1 5~ 4h) ,胰十二指肠切除术平均 5 5h( 4 5~ 6 5h)。所有病例术后恢复良好 ,无手术并发症出现。平均住院时间 18d( 12~ 2 3d)。随访时间 3 0 ( 3~ 48)个月 ,无肿瘤复发。回顾分析结果显示 ,螺旋CT在诊断十二指肠肿瘤方面具有优势 ,十二指肠降段及水平段良性或低度恶性肿瘤行十二指肠节段切除安全简便 ,切实可行 相似文献
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A case of intraductal tubulopapillary neoplasm of pancreas with severe calcification,a potential pitfall in diagnostic imaging 下载免费PDF全文
Shouichi Takayama Tamaki Maeda Masayoshi Nishihara Akifumi Kanazawa Hyon Su Chong Hiroshi Oka Seiichi Hirota Osamu Ishikawa 《Pathology international》2015,65(9):501-506
We experienced a case of intraductal tubulopapillary neoplasms (ITPN) of the pancreas with severe calcification, which complicated image diagnosis. A pancreas head tumor was detected in a Japanese female in her 50s. Early enhancement by contrast‐enhanced CT and coarse calcification suggested a neuroendocrine tumor, although the obstruction and dilation of the main pancreatic duct appeared to be an intraductal tumor. An endoscopic ultrasound‐guided fine needle aspiration biopsy specimen revealed adenocarcinoma tissue. Pancreaticoduodenectomy was performed, and the patient has been well without evidence of recurrence for over 10 months. Pathological examination on the resected specimen revealed that the tumor showed papillary and tubulo‐cribriform growth patterns. Together with typical immunohistochemical results, the final diagnosis of ITPN was made. Characteristically, this case showed extensive calcification of both psammoma body‐type and non psammoma body‐type with foamy macrophage aggregation. This is the first report of ITPN with two types of calcification and macrophage. Since calcification might be one of the characteristic histological findings in ITPN as shown in our case, the possibility of ITPN should be also considered when calcification is detected in pancreatic lesions by various imaging modalities. 相似文献
10.
Konstantinos Manes Dimitrios Lytras Costas Avgerinos Spiros Delis Christos Dervenis 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2008,10(6):472-476
Objective. The aim of our study focuses upon prevention of delayed gastric emptying (DGE) after pancreaticoduodenectomy using a alternative reconstruction procedure. Method. Forty consecutive patients underwent a typical pylorus-preserving pancreaticoduodenectomy (PPPD) with antecolic reconstruction in a two-year period (January 2002 until January 2004), while a similar group of 40 consecutive patients underwent PPPD with application of pyloric dilatation between January 2004 and January 2006. Early and late complications were compared between the two groups. Results. DGE occurred significantly more often in the group of patients treated by the classical PPPD technique (nine patients −22%) compared with those operated on with the addition of pyloric dilatation technique (two patients −5%) (p<0.05). The incidence of other complications did not differ significantly between the two groups. Conclusions. The application of dilatation may decrease the incidence of DGE after PPPD and facilitates earlier hospital discharge. 相似文献