中华普外科手术学杂志（电子版）
中華普外科手術學雜誌（電子版）
중화보외과수술학잡지（전자판）
CHINESE JOURNAL OF OPERATIVE PROCEDURES OF GENERAL SURGERY(ELECTRONIC VERSION)
2015年
4期
253-253
,共1页
胰腺肿瘤%胰十二指肠切除术%胆管肿瘤
胰腺腫瘤%胰十二指腸切除術%膽管腫瘤
이선종류%이십이지장절제술%담관종류
Pancreatic neoplasms%Pancreaticoduodenectomy%Bile buct neoplasms
胰十二指肠切除术主要用于治疗壶腹周围肿瘤，标准的切除范围包括胰头及钩突、十二指肠、胆总管、胆囊、远端胃及近端空肠，还需常规行胰头周围淋巴结清扫（包括第6、8、12、13、14、17组淋巴结），消化道重建包括胰空肠、胆管空肠及胃空肠吻合。该手术创伤大，术后并发症发生率较高达20％～40％。手术要点包括完整的胰腺钩突切除、规范的淋巴结清扫及满意的胰腺空肠吻合。本例患者为60岁女性，术前诊断为梗阻性黄疸、胆总管癌。行标准的胰十二指肠切除术，消化道重建采用Child顺序，胰腺空肠套入式吻合。手术用时4．3 h，出血约200 ml，未输血。术后患者恢复顺利，无并发症，术后2周出院。术后病理为胆总管下段中分化腺癌，淋巴结共22枚均无转移。
胰十二指腸切除術主要用于治療壺腹週圍腫瘤，標準的切除範圍包括胰頭及鉤突、十二指腸、膽總管、膽囊、遠耑胃及近耑空腸，還需常規行胰頭週圍淋巴結清掃（包括第6、8、12、13、14、17組淋巴結），消化道重建包括胰空腸、膽管空腸及胃空腸吻閤。該手術創傷大，術後併髮癥髮生率較高達20％～40％。手術要點包括完整的胰腺鉤突切除、規範的淋巴結清掃及滿意的胰腺空腸吻閤。本例患者為60歲女性，術前診斷為梗阻性黃疸、膽總管癌。行標準的胰十二指腸切除術，消化道重建採用Child順序，胰腺空腸套入式吻閤。手術用時4．3 h，齣血約200 ml，未輸血。術後患者恢複順利，無併髮癥，術後2週齣院。術後病理為膽總管下段中分化腺癌，淋巴結共22枚均無轉移。
이십이지장절제술주요용우치료호복주위종류，표준적절제범위포괄이두급구돌、십이지장、담총관、담낭、원단위급근단공장，환수상규행이두주위림파결청소（포괄제6、8、12、13、14、17조림파결），소화도중건포괄이공장、담관공장급위공장문합。해수술창상대，술후병발증발생솔교고체20％～40％。수술요점포괄완정적이선구돌절제、규범적림파결청소급만의적이선공장문합。본례환자위60세녀성，술전진단위경조성황달、담총관암。행표준적이십이지장절제술，소화도중건채용Child순서，이선공장투입식문합。수술용시4．3 h，출혈약200 ml，미수혈。술후환자회복순리，무병발증，술후2주출원。술후병리위담총관하단중분화선암，림파결공22매균무전이。
Pancreaticoduodenectomy ( Whipple 's procedure ) is mainly used for treatment of periampullary tumors. The classical extent of resection includes the pancreatic head, uncinate process, duodenum, common bile duct, gallbladder, distal stomach, and proximal jejunum, with a regular clearance of the lymph nodes around the head of pancreas (including group 6, 8, 12, 13, 14, and 17).The reconstructions of the digestive tract include pancreatic-jejunumanastomosis, cholangio-jejunostomy and gastro-jejunostomy. The postoperative complication rate is still as high as 20%-40%.The key points of this procedure include the complete resection of the uncinate process, standardized lymph node clearance, and satisfied pancreatic-jejunumanastomosis.In this article, we introduced a 60-year-old woman with a preoperative diagnosis of obstructive jaundice caused by common bile duct carcinoma.A standard Whipple procedure was performed for her, with an end-to-side invagination pancreaticojejunostomy.The duration of operation was 4 hours and 30 minutes, and blood loss was 200 ml without transfusion.The patient recovered uneventfully without any complication, and was discharged 2 weeks after surgery.The pathologic results showed a moderately differentiated adenocarcinoma of the distal common bile duct , and no metastasis was found among the 22 resected lymph nodes.
