捆绑式胰胃吻合术在中段胰腺切除术中的应用价值
곤방식이위문합술재중단이선절제술중적응용개치
Clinical application of binding pancreaticogastrostomy in the central pancreatectomy
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 11期 921-924 ,共4页

    康鹏程%姜兴明%万明%李春龙%钟翔宇%王志东%邰升%崔云甫

    강붕정%강흥명%만명%리춘룡%종상우%왕지동%태승%최운보

    胰腺肿瘤%胰腺损伤%中段胰腺切除术%捆绑式胰胃吻合%胰瘘 胰腺腫瘤%胰腺損傷%中段胰腺切除術%捆綁式胰胃吻閤%胰瘺
    이선종류%이선손상%중단이선절제술%곤방식이위문합%이루
    Pancreatic neoplasms%Pancreatic trauma%Central pancreatectomy%Binding pancreaticogastrostomy%Pancreatic fistula
    目的 探讨捆绑式胰胃吻合术(BPG)在中段胰腺切除术(CP)中的应用价值.方法 回顾性分析2010年1月至2014年10月哈尔滨医科大学附属第二医院收治的62例行CP并采用BPG进行重建的胰腺颈体部良性及低度恶性疾病患者的临床资料.其中56例患者为胰腺颈体部占位性病变:胰腺实性假乳头状瘤21例,胰腺神经内分泌肿瘤19例(其中13例为无功能性胰岛细胞瘤),胰腺囊腺瘤16例(其中浆液性囊腺瘤12例、黏液性囊腺瘤4例),均经术后病理学检查结果证实;6例为胰腺颈体部破裂伤.手术方式采用CP联合BPG.手术探查后,联合应用上入路和前入路切除胰腺中段;采用BPG进行消化道重建.记录患者手术时间、术中出血量、术后胃肠功能恢复时间、术后拔除引流管时间、术后住院时间及术后并发症情况.采用门诊和电话方式进行随访,随访内容包括患者血糖情况、胰腺外分泌功能情况及是否有胰腺假性囊肿形成等.随访时间截至2015年1月.结果 62例患者均顺利完成手术,无围术期死亡患者.平均手术时间为155 min(125～230 min),平均术中出血量为300 mL(210 ～425 mL),平均术后胃肠功能恢复时间为3.0d(2.0 ～5.0 d),平均术后拔除引流管时间6.0 d(4.0～10.0 d),平均术后住院时间为10.5 d(9.0～21.0 d).7例患者术后发生胃排空延迟,均经非手术治疗后痊愈.6例患者术后发生胰瘘,其中4例患者(均为A级)于住院期间愈合,2例患者(均为B级)带引流管出院,影像学检查证实胰瘘愈合后拔除引流管.2例患者术后发生出血,其中1例消化道出血行胃镜下烧灼止血,另1例腹腔出血行剖腹探查止血.所有患者获得随访,随访时间为3 ～36个月,中位随访时间为25个月.随访期间,无患者出现血糖增高、胰腺外分泌功能不足及胰腺假性囊肿形成.结论 CP创伤小,术后恢复快,可作为治疗胰腺颈体部良性或低度恶性肿瘤及损伤的首选手术方式.CP后行BPG胰瘘发生率低,安全可行,是CP理想的消化道重建方式.
    목적 탐토곤방식이위문합술(BPG)재중단이선절제술(CP)중적응용개치.방법 회고성분석2010년1월지2014년10월합이빈의과대학부속제이의원수치적62례행CP병채용BPG진행중건적이선경체부량성급저도악성질병환자적림상자료.기중56례환자위이선경체부점위성병변:이선실성가유두상류21례,이선신경내분비종류19례(기중13례위무공능성이도세포류),이선낭선류16례(기중장액성낭선류12례、점액성낭선류4례),균경술후병이학검사결과증실;6례위이선경체부파렬상.수술방식채용CP연합BPG.수술탐사후,연합응용상입로화전입로절제이선중단;채용BPG진행소화도중건.기록환자수술시간、술중출혈량、술후위장공능회복시간、술후발제인류관시간、술후주원시간급술후병발증정황.채용문진화전화방식진행수방,수방내용포괄환자혈당정황、이선외분비공능정황급시부유이선가성낭종형성등.수방시간절지2015년1월.결과 62례환자균순리완성수술,무위술기사망환자.평균수술시간위155 min(125～230 min),평균술중출혈량위300 mL(210 ～425 mL),평균술후위장공능회복시간위3.0d(2.0 ～5.0 d),평균술후발제인류관시간6.0 d(4.0～10.0 d),평균술후주원시간위10.5 d(9.0～21.0 d).7례환자술후발생위배공연지,균경비수술치료후전유.6례환자술후발생이루,기중4례환자(균위A급)우주원기간유합,2례환자(균위B급)대인류관출원,영상학검사증실이루유합후발제인류관.2례환자술후발생출혈,기중1례소화도출혈행위경하소작지혈,령1례복강출혈행부복탐사지혈.소유환자획득수방,수방시간위3 ～36개월,중위수방시간위25개월.수방기간,무환자출현혈당증고、이선외분비공능불족급이선가성낭종형성.결론 CP창상소,술후회복쾌,가작위치료이선경체부량성혹저도악성종류급손상적수선수술방식.CP후행BPG이루발생솔저,안전가행,시CP이상적소화도중건방식.
    Objective To investigate the clinical application of binding pancreaticogastrostomy (BPG) in the central pancreatectomy (CP).Methods The clinical data of 62 patients with benign and low-grade malignant lesions in the neck and body of pancreas who received CP combined with BPG from January 2010 to October 2014 were retrospectively analyzed.Fifty-six patients with space-occupying lesions of the head and neck of pancreas were confirmed by postoperative pathological examinations, including 21 solid pseudopapillary tumors of pancreas (SPTPs), 19 pancreatic neuroendocrine neoplasms (PNENs) (13 non-functional islet cell tumors) , 16 pancreatic cystic tumors (12 serous cystadenomas and 4 mucinous cystadenomas) and 6 ruptures in the head and neck of pancreas.CP combined with BPG was performed.The central pancreas was resected via upper and anterior approaches after surgical exploration, and digestive tract reconstruction was applied using BPG.The operation time, volume of intraoperative blood loss, time of postoperative gastrointestinal function recovery., drainage tube removed time, duration of hospital stay and postoperative complications were recorded.Patients were followed up by outpatient examination and telephone interview up to January 2015, and follow-up included the level of blood glucose, conditions of pancreatic exocrine function and with or without pancreatic pseudocyst.Results All the patients underwent successful operation without perioperative death.The average operation time, average volume of intraoperative blood loss, average time of postoperative gastrointestinal function recovery, average drainage tube removal time and average duration of postoperative hospital stay were 155 minutes (range, 125-230 minutes), 300 mL (range, 210-425 mL), 3.0 days (range, 2.0-5.0 days), 6.0 days (range, 4.0-10.0 days) and 10.5 days (range, 9.0-21.0 days), respectively.Seven patients with delayed gastric emptying were cured by non-surgical treatment.Of 6 patients complicated with pancreatic fistula, 4 patients (Grade A) had healed pancreatic fistulas during hospitalization, 2 patients (Grade B) with drainage tubes were discharged from hospital and then drainage tubes were removed after confirming healed pancreatic fistula by imaging examination.Of 2 patients with intraperitoneal hemorrhage, 1 underwent under gastroscope cauterisation for hemostasis and 1 underwent open reoperation for hemostasis.All the patients were followed up for 3-36 months with a median time of 25 months and without high blood glucose, pancreatic exocrine function insufficiency and pancreatic pseudocyst.Conclusions CP with the advantages of minimal invasion and quick recovery can be used as a priority surgical method for benign or low-grade malignant tumors and injures in the neck and body of pancreas.BPG is safe and feasible as well as reduce the incidence of pancreatic fistula after CP, and it is an ideal reconstruction.
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