胰头部肿块手术方式选择及评价

胰头部肿块解剖位置特殊，病理类型多样，治疗应采取个体化原则，对于胰头部实性包块，术前应重视肿块型胰腺炎和胰腺癌的鉴别，胰十二指肠切除术是胰头癌的经典术式，关于保留幽门的胰十二指肠切除，扩大淋巴结清扫范围及联合血管切除目前仍无共识，可酌情选用。近年来保留十二指肠的胰头切除术在治疗胰头肿块型胰腺炎中体现出一定优越性。对于术中仍无法区别良恶性者，不必过分强调病理结果，选择胰十二指肠切除术是可以接受，也是值得的。对于胰头部囊性及囊实性肿块，应根据肿瘤大小、位置、病理类型选用假性囊肿内、外引流、单纯摘除、保留十二指肠的胰头切除、胰腺节段切除及胰十二指肠切除术等，注意囊性肿块鉴别诊断，避免误将囊性肿瘤按假性囊肿行内引流术。

Surgical treatment of pancreas head mass lesions:strategy and evaluation

Surgical treatment of pancreas head mass lesions:strategy and evaluation ZHANG Tai-ping, ZHAN Han-xiang, XIE Yong,et al. Department of Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730, China Corresponding euthor:ZHAO Yu-pei, E-mail:zhao 8028@263.net Abstract Because of the special Anatomical location and diversity of pathology, surgical treatment of pancreas head mass lesions should be individual. For the solid mass,it is important to distinguish chronic pancreatitis with mass in the head of the pancreas with pancreatic carcinoma before operation process. Pancreaticoduodenectomy is the classical operation for pancreatic head carcinoma. There is still no consensus for the widely application of PPPD,ELND and VR, so they can be Selected conditionally. Duodenum-preserving pancreatic head resection has certain superiority in the treatment of pancreatic head mass lesions. Do not have too much emphasis on the pathological results of the atypical cases. Pancreaticoduodenectomy is acceptable and worthwhile for these patients.For the cystic and cystic-solid mass in the pancreas head, the operation process should be based on tumor size, location, pathological type and so on.External and internal drainage,tumor enucleation, duodenum-preserving pancreatic head resection,segmental resection,Whipple procedure are the usual applied operation process.Inside drainage should be avoided for the pancreas cystic tumors.