CAJ | 학술논문

保留十二指肠和胆管的胰头全切除术(Takada法),手术难度大,在国内开展较少.2013年9月至2014年5月福建省漳州正兴医院和漳州市医院对5例患者(1例胰头部肿块型胰腺炎,2例胰管黏液性囊腺瘤伴灶性癌变,2例慢性胰腺炎、胰管多发结石)施行该手术.5例患者采用Takada法切除病变,联合一期行胰管原位重建,其中胆总管探查引流1例.手术时间为210 ～ 330 min,术中出血量为100 ～500mL,平均术中出血量为300 mL.2例患者为鹿角形结石,3例患者为肿瘤,均无手术死亡.术后发生胰液漏及胆汁漏各1例,均经非手术治疗痊愈.患者术后随访3～11个月无糖代谢异常、胆总管狭窄、慢性消化不良发生及肿瘤复发.对于胰头部肿块型慢性胰腺炎、胰头部良性病变、胰头部低度恶性肿瘤,Takada法安全、有效,患者术后恢复快.
보류십이지장화담관적이두전절제술(Takada법),수술난도대,재국내개전교소.2013년9월지2014년5월복건성장주정흥의원화장주시의원대5례환자(1례이두부종괴형이선염,2례이관점액성낭선류반조성암변,2례만성이선염、이관다발결석)시행해수술.5례환자채용Takada법절제병변,연합일기행이관원위중건,기중담총관탐사인류1례.수술시간위210 ～ 330 min,술중출혈량위100 ～500mL,평균술중출혈량위300 mL.2례환자위록각형결석,3례환자위종류,균무수술사망.술후발생이액루급담즙루각1례,균경비수술치료전유.환자술후수방3～11개월무당대사이상、담총관협착、만성소화불량발생급종류복발.대우이두부종괴형만성이선염、이두부량성병변、이두부저도악성종류,Takada법안전、유효,환자술후회복쾌.
Duodenum-and bile duct-preserving pancreatic head resection is rarely carried out in China due to its complexity.From September 2013 to May 2014,5 patients (1 with mass-forming pancreatitis of the head of the pancreas,2 with mucinous cystadenoma of the pancreatic duct combined with focal cancerous,2 with chronic pancreatitis and pancreatic duct stones) received duodenum-and bile duct-preserving pancreatic head resection at the Zhangzhou Zhengxing Hospital.The lesions of the 5 patients were resected by the Takada method and then the pancreatic duct was reconstructed in situ.One patient received T-tube drainage of the bile duct.The operation time was 210-330 minutes,and the mean volume of intraoperative blood loss was 300 mL (range,100-500 mL).The stones of 2 patients were antler-shaped,and the other 3 patients were with tumor.No patients died intraoperatively.One patient was complicated by pancreatic leakage and 1 by bile leakage after the operation,respectively,and they were cured by non-surgical treatment.Patients were followed up for 3-11 months,and no abnormal glucose metabolism,common bile duct stricture,chronic indigestion and tumor recurrence occurred.The Takada method is safe and effective for the treatment of mass-forming pancreatitis of the head of the pancreas,benign lesions of the head of the pancreas and low-grade malignant tumor of the head of the pancreas.