胰管修复外科在胰腺囊腺瘤手术的临床应用

doi:10.3877/cma.j.issn.1674-6899.2022.02.005

目的

探讨胰管修复外科的术式在治疗胰腺囊腺瘤的临床疗效。

方法

回顾性分析2016年9月至2021年9月期间解放军总医院第一医学中心采用胰管修复外科术式治疗的胰腺囊腺瘤52例患者临床资料。

结果

21例为局部切除＋主胰管修复术，其手术时间、术中出血量、肿瘤最大直径、术后住院时间中位数分别为135 min、20 ml、2.6 cm、9.0 d，B级胰瘘率33.3%；31例胰腺端端吻合术，其手术时间、术中出血量、肿瘤最大直径、术后住院时间中位数分别为132 min、50 ml、2.5 cm、6.0 d，B级胰瘘率41.9%；术后严重并发症1例，术后出血1例，两种术式均无二次手术、死亡病例。

结论

胰管修复外科在胰腺囊腺瘤手术的临床应用是安全、可行的，能最大程度地保留胰腺组织结构和其生理功能，避免了胃肠道的损伤与骚扰。

关键词: 胰腺囊腺瘤, 胰管修复外科, 胰腺中段切除

Objective

To investigate the clinical effect of pancreatic duct reconstructive in the treatment of pancreatic cystadenoma.

Methods

The clinical data of 52 patients with pancreatic cystadenoma underwent pancreatic duct reconstructive surgery in our department from Sep. 2016 to Sep. 2021 were retrospectively analyzed.

Results

21 patients were treated with enucleation + pancreatic duct reconstructive. The median of operation time, estimated blood loss, tumor size, and postoperative hospital stay were 135 min, 20 ml, 2.6 cm, and 9.0 days, respectively. And the grade B pancreatic fistula rate was 33.3%. 31 patients were treated with end-to-end pancreatic anastomosis. The median of operation time, estimated blood loss, tumor size, and postoperative hospital stay were 132 min, 50 ml, 2.5 cm, 6.0 days, and the grade B pancreatic fistula rate was 41.9%. There was 1 case of serious complication, 1 case of postoperative haemorrhage. There was no second operation and death in both group.

Conclusions

Pancreatic duct reconstructive surgery for pancreatic cystadenoma is safe and feasible. This procedure can preserve the pancreatic tissue structure and its physiological function, avoiding damage the gastrointestinal tract.

Key words: Pancreatic cystadenoma, Pancreatic duct reconstructive surgery, Middle segmental pancreatectomy

图1 局部切除＋主胰管修复术注：A.MRI冠状位图，肿瘤(红色箭头)位于胰颈体部，与主胰管(蓝色箭头)邻近；B.切除肿瘤后主胰管破损口(红色箭头)；C.放置硅胶管于主胰管内；D.术中超声明确硅胶管位置及胰管连续性；E.主胰管破口缝扎；F.将两端胰腺对拢包埋胰管

图2 胰腺端端吻合术注：A.MRI，显示胰颈部直径较大，呈分隔状的囊腺瘤；B.肿瘤两端完整切除，显露脾动脉(红色箭头)、脾静脉(蓝色箭头)；C.硅胶管置入近、远端胰管，长度约4.5 cm；D.术中超声明确主胰管内硅胶管连续性；E.远、近端的胰腺残端进行贯穿缝合，硅胶管附近可吸收线U形缝扎；F.在充分游离近、远端胰腺后，两端对拢缝合

表1 胰腺囊腺瘤患者术中及术后情况

项目		局部切除＋主胰管修复术(21例)	胰腺端端吻合术(31例)
手术时间(min，中位数)		135	132
术中出血量(ml，中位数)		20	50
术中输血[例(%)]		0(0.0)	0(0.0)
术后出血[例(%)]		0(0.0)	1(3.2)
肿瘤最大直径(cm,中位数)		2.6	2.5
临床相关性胰瘘[例(%)]		7(33.3)	13(41.9)
	B级	7(33.3)	13(41.9)
	C级	0(0.0)	0(0.0)
严重并发症(Clavien分级≥3) [例(%)]		0(0.0)	1(3.2)
术后住院时间(d，中位数)		9.0	6.0
术后90 d二次手术[例(%)]		0(0.0)	0(0.0)
术后90 d死亡[例(%)]		0(0.0)	0(0.0)

表1 胰腺囊腺瘤患者术中及术后情况

项目		局部切除＋主胰管修复术(21例)	胰腺端端吻合术(31例)
手术时间(min，中位数)		135	132
术中出血量(ml，中位数)		20	50
术中输血[例(%)]		0(0.0)	0(0.0)
术后出血[例(%)]		0(0.0)	1(3.2)
肿瘤最大直径(cm,中位数)		2.6	2.5
临床相关性胰瘘[例(%)]		7(33.3)	13(41.9)
	B级	7(33.3)	13(41.9)
	C级	0(0.0)	0(0.0)
严重并发症(Clavien分级≥3) [例(%)]		0(0.0)	1(3.2)
术后住院时间(d，中位数)		9.0	6.0
术后90 d二次手术[例(%)]		0(0.0)	0(0.0)
术后90 d死亡[例(%)]		0(0.0)	0(0.0)

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Application of pancreatic duct reconstructive surgery in pancreatic cystadenoma

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