CAJ | 학술논문

目的探讨Cattell Braasch去旋转手法在胰腺肿瘤手术中的操作技巧、应用价值及并发症情况.方法对术中使用Cattell Braasch去旋转手法做为显露及探查手法的13例胰腺肿瘤的临床资料进行总结分析.结果 13例患者中胰头部肿瘤6例(腺癌4例,实性假乳头状瘤及内分泌肿瘤各1例),胰体尾肿瘤7例(腺癌4例,实性假乳头状瘤1例,内分泌肿瘤2例).行胰十二指肠切除6例,其中3例行肠系膜上静脉节段切除对端吻合术,血管切除长度3～7 cm;根治性胰体尾脾切除术7例,其中联合左肾切除1例.手术均获得成功,术中应用该手法的操作时间为10～15 min,手术时间为2.5～11 h.术中出血300～1000 ml,全部病例均未发生毗邻组织的意外损伤,术后无腹泻、系膜扭转、肠梗阻以及肠系膜上静脉血栓形成等严重并发症发生,无手术死亡病例.结论 Cattell Bransch去旋转手法是一种安全有效的外科手法,可以改善胰腺肿瘤的手术显露,简化局部解剖关系,避免意外损伤,增加手术的安全性;同时通过该手法可以松解肠系膜上静脉,有助于施行受侵犯的肠系膜上静脉长段切除后的直接对端吻合.
목적 탐토Cattell Braasch거선전수법재이선종류수술중적조작기교、응용개치급병발증정황.방법 대술중사용Cattell Braasch거선전수법주위현로급탐사수법적13례이선종류적림상자료진행총결분석.결과 13례환자중이두부종류6례(선암4례,실성가유두상류급내분비종류각1례),이체미종류7례(선암4례,실성가유두상류1례,내분비종류2례).행이십이지장절제6례,기중3례행장계막상정맥절단절제대단문합술,혈관절제장도3～7 cm;근치성이체미비절제술7례,기중연합좌신절제1례.수술균획득성공,술중응용해수법적조작시간위10～15 min,수술시간위2.5～11 h.술중출혈300～1000 ml,전부병례균미발생비린조직적의외손상,술후무복사、계막뉴전、장경조이급장계막상정맥혈전형성등엄중병발증발생,무수술사망병례.결론 Cattell Bransch거선전수법시일충안전유효적외과수법,가이개선이선종류적수술현로,간화국부해부관계,피면의외손상,증가수술적안전성;동시통과해수법가이송해장계막상정맥,유조우시행수침범적장계막상정맥장단절제후적직접대단문합.
Objective To introduce the standard procedure of Cattell Braasch maneuver and evaluate the complication and clinical value of this maneuver as a important exploration method in the surgery of pancreatic tumors. Method The clinical data of 13 cases of pancreatic tumors explored by Cattell Braanch maneuver before undergoing tumor resection were analyzed. Results Among these 13 cases there were 6 cases of tumors of the head (the pancreatic adeuocarcinoma in 4 cases, solid pseudo-papillary tumor and endocrine tumor in one each cases) and 7 cases of tumor of the body and tail of the pancreas (adenocarcinoma in 4 cases, solid pseudo-papillary tumor in 1 case, endocrine tumor in 2 cases) Pancreaticoduodenectomy was performed in 6 cases, including segmental resection of the tumor invading the superior mesenteric vein( SMV )with length varying from 3 to 7 cm and direct end-to-end reanastomosis in 3 cases. Distal pancreatectomy plus spleuectomy was performed in the other 7 cases, including the case in which extended tumor resection demanded left nephrectomy. Operations lasted from 2. 5 hrs to 11 hrs, in which only 10 ～ 15 mins were needed for Cattell Braasch maneuver . The blood lose was from 300 ml to 1000 ml. There were neither mortality nor severe complications in these series. Conclusion Cattell Braasch maneuver facilitates the exploration and tumor resection in patients suffering from pancreatic neoplasms especially malignances with better view of the operation field,it helps to avoid incidental iatrogenic injury, and also to the nongraft PV/SMV end-to-end anastomosis after the resection of tumor invaded segment.