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目的探讨4种保留器官功能胰腺切除术的适应证、并发症及治疗效果。方法回顾性总结1990年1月至2012年3月中国医科大学附属第一医院普通外科施行的76例保留器官功能胰腺切除术的临床资料,其中男21例,女55例。年龄15～75岁。除胰腺壶腹癌及胰腺外伤各1例外,其余均为胰腺良性或低度恶性病变。76例中,行保留幽门的胰十二指肠切除术(PPPD)8例、保留十二指肠的胰头切除术(DPPHR)14例、中段胰腺切除术(CP)14例、保留脾脏的远侧胰腺切除术(SPDP)40例。结果无手术死亡。发生手术并发症13例(17.1%),其中胰瘘11例(14.5%),胆瘘1例(1.3%),术后胰肠吻合口出血1例(1.3%)。8例行PPPD的病人中,1例发生胰瘘。14例行DPPHR的病人中,发生胰瘘2例、胆瘘1例。行CP的14例病人中,2例发生胰瘘,1例术后合并胰肠吻合口出血者行手术治疗后治愈。40例行SPDP的病人中6例发生胰瘘,未发生迟发性脾梗死、脾脓肿或血小板升高。结论保留器官功能的胰腺切除术可明显减轻手术创伤、保留器官功能、降低手术并发症发生率,疗效与传统术式相似,应作为胰腺良性或低度恶性病变的首选术式。

The organ-preserving pancreatectomy:reports of 76 cases

??The organ-preserving pancreatectomy ?? reports of 76 cases QIN Hong*, DONG Ming, ZHOU Jian-ping, et al. *Department of Gastroenterological Surgery, the First Hospital of China Medical University, Shenyang 110001, China
Corresponding author??DONG Ming, E-mail: mingdong@mail.cmu.edu.cn
Abstract Objective To discuss the indication, complication and therapeutic efficacy of the four kinds of organ-preserving operation in pancreatectomy. Methods 76 clinical cases from January 1990 to March 2012 were retrospectively analyzed in general surgery of First Hospital of China Medical University. Among the total, 21 patients were male, 55 were female, age between 15 to 75yr. They were all benign or low-grade malignant lesions of pancreas except for one case of malignant tumor of the pancreas and one case of pancreatic trauma. Among the 76 clinical cases, 8 were pylorus-preserving pancreatoduodenectomy??PPPD??, 14 were duodenum-preserving pancreatic head resection??DPPHR??, 14 were central pancreatectomy??CP?? and 40 were spleen-preserving distal pancreatectomy??SPDP??. Results No mortality rate developed. There were 13??17.1%?? complications caused by operation. Among them, 11 were pancreatic fistula??14.5%??, 1 was biliary fistula, 1 was hemorrhage of pancreatic-intestinal stoma??14.5%??. PPPD done in 8 patients occurred 1 pancreatic fistula. DPPHR done in 14 patients occurred 2 pancreatic fistula, 1 biliary fistula. CP done in 14 patients occurred 2 pancreatic fistula, 1 hemorrhage of pancreatic-intestinal stoma which was cured by operation. SPDP done in 40 patients occurred 6 pancreatic fistula, and no delayed splenic infarction, splenic abscess or platelet-elevating occurred. Conclusion Organ-preserving pancreatectomy could reduce the operation trauma, preserve organ function, reduce the rate of complication caused by operation, and have the same efficacy as the traditional type of pancreatic operation, so it could be the first considered operation of benign or low-grade malignant lesions of pancreas.