根据胰高血糖素(Glueagon)分泌评价胰十二指肠根治术

壶腹周围癌施行全胰腺或胰十二指肠切除术,导致胰岛素和胰高血糖素分泌缺乏,碳水化合物代谢失调。本文报告壶腹周围癌病人术前术后胰岛A-细胞的功能变化。 [资料和方法] 10例壶腹周围癌病人,5例胰头癌,3例壶腹乳头状癌,2例壶腹癌,所有病人均行胰十二指肠切除。术前一周,术后4～15周(平均7.5     

壶腹周围癌胰十二指肠切除术预后因素

胆总管下端、壶腹、十二指肠乳头及胰头的恶性肿瘤因为临床表现相似,临床上统称壶腹周围癌。壶腹周围癌的早期诊断和治疗方面一直存在困难,唯一可能治愈的方法是手术切除,如胰十二指肠切除术（pancreaticoduodenectomy,PD）。肿瘤根治术后整体长期存活率是外科医牛所共同关注的问题。就PD术预后而言,壶蝮部癌及十二指肠乳头部癌最高,远端胆管癌次之,胰头癌最差。对于壶腹周旧癌行PD术后存活率的相关因素,得到公认的包括肿瘤病理来源、细胞分化程度、TNM分期等。而近年国内外在该方而又有了深入研究,现就壶腹周围癌PD术后预后相关因素的研究进展综述如下。     

胰十二指肠切除术治疗壶腹部癌和胰头癌临床分析

壶腹周围癌是指胆胰壶腹周围2cm范围内的恶性肿瘤，包括壶腹部癌（胆总管末端壶腹癌和十二指肠乳头癌）、胰头癌及十二指肠降段的恶性肿瘤．胰十二指肠切除术是治疗壶腹周围癌的主要方式，但该手术对于壶腹部癌和胰头癌的疗效有所差别．将我院近7年收治病例的情况报道并分析如下。     

胰十二指肠切除在治疗85例壶腹周围癌的经验

目的 探讨对壶腹周围肿瘤施行胰十二指肠切除术的经验。方法 回顾性总结施行胰十二指肠切除术85例的临床资料,分析壶腹周围癌的早期诊断、手术方式,即标准胰十二指肠切除(SPD)保留幽门胰十二指肠切除(PPPD)和扩大胰十二指肠切除术(EPD)。全组病例消化道重建采用Child术式,空肠-胰腺端端套入法。结果 ①全组病例经病理确诊,其中胰头癌37例,乏特壶腹癌26例,胆管下段癌19例,十二指肠癌3例。胰周淋巴转移率为32.56％。②并发症:全组无术中死亡。术后并发上消化道出血3例(3.49％),肺部感染3例,胃排空障2例(2.33％),伤口、腹腔感染3例,术中大出血1例,胆瘘1例,多器官功能衰竭死亡1例。③生存率:全组病例获得随访,1、3、5年生存率分别为75.62％、34.64％、13.53％。结论 ①早期诊断是提高壶腹周围癌手术切除率和生存率的关键。强调对高危人群的检测、肿瘤标记物检查、早期B超、CT、螺旋CT三维成像等检查有助于早期诊断。②合理选择手术病例和方式,作者认为胰头癌原则上行PD,壶腹癌、胆管下段癌、十二指肠癌可考虑行PPPD,适当选择侵犯SMV-PV的病例施行EP手术是安全可行的。③预防胰瘘是降低PP病死率的关键。④做好围手术期处理是提高PP疗效的重要措施。     

胆胰十二指肠结合部切除治疗壶腹部周围癌的疗效分析

目的探讨胆胰十二指肠结合部切除治疗壶腹部周围癌的临床应用。方法自2005年1月—2006年7月采用该术式治疗壶腹部周围癌15例，其中乳头癌6例，壶腹癌5例，胆总管下端癌4例。合并心肺疾患7例，糖尿病2例。切除范围：十二指肠降段，距胆胰管汇合部切除胰头1—2cm及胆总管至左右肝管汇合处下方。术中注意清扫区域淋巴结，行冰冻病理切片检查证实各切缘无肿瘤残存。结果全组手术成功率为100％，术后未出现胃瘫、十二指肠漏、胆漏或明显胰漏等严重并发症，均痊愈出院。1例死于术后2个月上消化道应激性溃疡大出血，其余14例均存活。随访3—16个月，随访期间未发现肿瘤复发或转移。结论胆胰十二指肠结合部切除术是治疗壶腹部周围癌的一种新术式，比乳头局部切除术范围大，但是手术难度和创伤均较常规胰十二指肠切除术明显降低，近期疗效满意。     

肠系膜上动脉路径在胰十二指肠切除及合并血管切除术中的应用

目的：探讨经肠系膜上动脉途径行胰头十二指肠切除及合并血管切除的可行性及优劣。 方法：2012年9月—2014年2月采用肠系膜上动脉旁路径的方法实施胰头十二指肠切除术治疗胰头癌及壶腹周围癌16例,其中实施门静脉、肠系膜上静脉切除重建手术5例。患者均首先显露、游离肠系膜上动、静脉并清除其周围的神经淋巴组织,再打通胰后隧道并切断胰腺颈部,最后切除胰腺钩突或被侵犯的门静脉、肠系膜上静脉。 结果：15例术后顺利恢复后出院,1例术后出现肾功能衰竭、肺部感染,放弃治疗自动出院。术中平均出血量为470 mL,平均手术时间4.5 h,无手术中及术后死亡。5例术后出现胰瘘等并发症,均经保守治疗后痊愈。切缘病理检查均阴性,淋巴结及后腹膜神经、淋巴组织阳性检出率较高。 结论：经肠系膜上动脉途径行胰头十二指肠切除术治疗胰头癌及壶腹周围癌安全可行,并可增加R0切除率。     

老年壶腹周围肿瘤胰十二指肠切除术后30天内死亡预后因素分析

目的 分析老年壶腹周围肿瘤胰十二指肠切除术后30 d内死亡预后因素.方法 回顾性分析1985年1月至2006年11月收治的127例接受胰十二指肠切除术的老年壶腹周围肿瘤患者的临床资料.以术后30 d内死亡为结局变量,采用Chi-squared检验、Fisher精确概率检验以及t检验找出预后因素.结果 手术用时长、术中出血量、术后出血、肺部感染和术后总蛋白量低是老年壶腹周围肿瘤患者胰十二指肠切除术后30 d内死亡的预后因素.结论 老年壶腹周围肿瘤患者施行胰十二指肠切除术应正确处理手术用时长、术中出血量、术后出血、肺部感染和术后总蛋白量低等预后因素.     

全脏器反位合并十二指肠乳头癌、卵巢癌一例

完全胸腹腔脏器反位(situs inversus totslis)系罕见的先天性畸形，其发病率为十万分之一。至1992年全世界仅12例内脏全反位合并癌症的报道。1995年以来，国内报道了全脏器反位合并食管癌、贲门癌、肝癌、乳腺癌、直肠癌等病例，但尚未见有异时发生卵巢癌、十二指肠乳头癌的报道。     

Vater壶腹部周围癌胰十二指肠切除术后胰瘘的危险因素及对策

<正>Vater壶腹部周围癌是指胆胰壶腹周围2cm范围内的恶性肿瘤,包括胆总管下端癌、壶腹癌、十二指肠乳头癌和胰头癌。胰十二指肠切除术(pancreaticoduodenectomy,PD)是主要的根治性治疗手段。胰瘘(pancreatic fistula,PF)是PD常见的严重并发症之一。胰瘘的定义不尽相同,为了便于比较和国际交流,术后胰瘘国际研究小组规定,只要术后     

改良Vater壶腹部切除的根治术治疗壶腹周围癌

目的：探讨行壶腹部改良切除术治疗Vater壶腹部周围癌,减少非肿瘤器官切除,提高疗效的手术方法。方法：总结1995－1998年13例壶腹周围癌行扩大壶腹部切除的根治术的经验,经十二指肠后外侧入路,整块切除肝外胆道,胆胰管汇合部,壶腹部及十二指肠乳头,十二指肠乳头封闭术,胆,胰,十二指肠间置空肠或胆,胰空肠Roux-en-y吻合术。结果：围手术期死亡1例,并发 1例经再手术治愈,随访术后半年以上9例,最长生存29个月,无并发症及转移征象。结论：（1）该术式符合胰十二指肠解剖关系;（2）按肿瘤治疗原则能达到广泛程度清扫;（3）初行该术式者应掌握胰十二指肠切除术。     

Pancreas head carcinoma associated with situs inversus viscerum totalis

The patient was a seventy seven years old male whose chief complaint was jaundice. Chest and abdomen roentgenogram showed situs inversus viscerum totalis. Echographically, pancreas head tumor was showed. Stenosis of inferior bile duct and dilatation of main pancreatic duct were showed by percutaneous transhepatic cholangiography and endoscopic retrograde cholangio pancreaticography. So, pancreas head carcinoma associated with situs inversus viscerum totalis was diagnosed. Pancreaticoduodenectomy and modified Child method was undergone. At the time of operation, liver was recognized left side of abdomen. The tumor was diagnosed well or moderately differentiated papillotubular adenocarcinoma by pathological study. This unusual combination of situs inversus viscerum totalis and pancreas head carcinoma was reported.     

Laparoscopic cholecystectomy in two patients with symptomatic cholelithiasis and situs inversus totalis

BACKGROUND: Situs inversus viscerum is a rare condition with a genetic predisposition. We report 2 patients with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy. PATIENTS AND METHODS: The first patient was a 61-year-old female presenting with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and rebounding pain in the same region. Abdominal ultrasound and CT scan confirmed the diagnosis of gallstones as well as situs inversus with the liver and gallbladder on the left side and the spleen on the right. The second patient was a 37-year-old male with known situs inversus who presented with biliary colic due to cholelithiasis. In both patients cholecystectomy was performed laparoscopically in a reverse fashion. RESULTS: Laparoscopic cholecystectomy was carried out successfully despite the reversed anatomic relationships and both patients made a smooth recovery. CONCLUSION: Cholelithiasis occurring with situs inversus totalis is rare and may present a diagnostic problem. Laparoscopic cholecystectomy can be safely and effectively applied in the setting of situs inversus, although attention must be paid to the details of left-right reversal.     

Three-trocar laparoscopic cholecystectomy in patient with situs viscerum inversus totalis: case report and review of the literature

Situs viscerum inversus totalis is a rare defect with a genetic predisposition, which can present difficulties in the management of abdominal pathology, especially in laparoscopic surgery (mirror-image anatomy). We report the case of a 52-year-old female with situs viscerum inversus totalis, known from pediatric age, with a medical history of colic pain in the epigastrium radiating to the right abdominal quadrant. Laparoscopic cholecistectomy was safely performed with a three trocar technique. To the best of our knowledge this is the first time that laparoscopic cholecistectomy by three trocars was performed in a patient with situs viscerum inversus. We also review the relevant literature concerning this issue.     

Symptomatic aorto-iliac aneurysm and situs viscerum inversus: case report

We report a case of infrarenal symptomatic aorto-iliac aneurysm in a patient with acute abdominal pain. The patient was admitted to the emergency care unit for abdominal pain and CT scans showing an infrarenal aorto-iliac aneurysm in a situs viscerum inversus (SVI) totalis syndrome. The patient underwent open aneurysm repair with an aorto-iliac bifurcated graft. This case shows that situs viscerum inversus cannot be considered a technical problem for the surgical treatment of abdominal aortic aneurysm.     

Laparoscopic Sleeve Gastrectomy for a Super-Super-Obese Patient with Situs Inversus Totalis

Situs inversus totalis is a rare defect which can present difficulties in the management in laparoscopic surgery due to the mirror-image anatomy. Herein, we report a patient with situs inversus totalis and super-super-obesity (BMI 76 kg/m²). We performed successful laparoscopic sleeve gastrectomy. Technical details of this operation, with situs inversus totalis, are presented. There were no major difficulties compared to patients with usual anatomy. There are potential diseases associated with situs inversus and obesity; therefore, a careful investigation, including a chest x-ray and cardiac and abdominal ultrasounds should be performed before surgery. Sleeve gastrectomy is an adequate procedure in super-super-obese patients with situs inversus totalis.     

全内脏转位的腹腔镜胆囊切除术4例报告

目的:探讨全内脏转位并胆囊结石患者施行腹腔镜胆囊切除术(laparoscop ic cholecystectomy,LC)的可行性及手术方法。方法:对1992年10月~2006年10月施行的8 256例LC中遇到的4例全内脏转位患者的临床资料进行回顾性总结。结果:4例全内脏转位患者均采用3孔法完成LC术,无中转开腹,全组患者术后均未放置腹腔引流管,恢复良好。结论:全内脏转位合并胆囊结石或胆囊息肉患者行LC是安全可行的,可与常规LC取得同样满意的临床效果。     

Laparoscopic Nissen fundoplication in a patient with situs inversus totalis: an ergonomic consideration

We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease in a patient with situs inversus totalis. The 65-year-old man was previously diagnosed with situs inversus totalis and presented with chronic gastroesophageal reflux disease inadequately controlled by medications. The laparoscopic procedure was performed with 5 ports placed in a mirror-image configuration and with the patient in the lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient, was considered critical to the success of this case. In situs inversus totalis, this position provides the least visual disorientation from the reversed abdominal organs. We recommend this position for all upper abdominal laparoscopic procedures in patients with situs inversus totalis, including laparoscopic cholecystectomy.     

Laparoscopic hemicolectomy in a patient with situs inversus totalis after open distal gastrectomy

Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.     

Adenocarcinoma of pancreas with situs viscerum inversus totalis

A case of adenocarcinoma of the head of the pancreas in a patient with situs viscerum inversus totalis, an association described for the third time in literature, is reported. The possible coexistence of malformations of transposed organs and the specular anatomosurgical situation requires particular attention in the diagnosis and preoperative evaluation as well as a careful reorientation of the surgical perspective and a correct surgical conduct.     

Situs Inversus Totalis with Malignant Lymphoma of the Stomach: Report of a Case

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A follow-up CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy. Received: April 25, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: S. Murakami