Repeated Pancreatectomy after Pancreatoduodenectomy

Background When pancreatic duct dilatation is found in the patient having undergone pancreatoduodenectomy (PD), observation is chosen in most cases. Similarly, recurrent tumor in the remnant pancreas of invasive ductal carcinoma (IDC) of the pancreas is seldom indicated for resection. We have aggressively performed repeated pancreatectomy for these cases and obtained good results. Methods Repeated pancreatectomy after PD was performed for three types of circumstances: (1) pancreatodigestive anastomotic stricture; (2) neoplasm after intraductal papillary mucinous neoplasm (IPMN); and (3) recurrence of IDC of the pancreas. Results Resection of anastomosis and reanastomosis was performed for pancreatodigestive stricture in four patients. Symptoms derived from pancreatitis in three patients resolved by the second operation and did not recur during follow-up. None of the four patients required pancreatic enzyme substitution because of clinically overt malabsorption, and the defecation frequency of the four patients was within twice a day. Mild diabetes mellitus has been identified in only one patient who had diabetes mellitus before the second surgery. Completion pancreatectomy and pancreatic tail resection was performed for recurrence in two patients and IDC in one patient, respectively, after PD for IPMN. Intrapancreatic recurrences of IPMN in two patients existed in the main pancreatic ducts. As CT revealed pancreatic duct dilatation but not intraductal tumors, recurrences were not correctly diagnosed before the second operation. Completion pancreatectomy was performed for recurrence of IDC in two patients. One patient who underwent completion pancreatectomy for recurrence of IDC survived 66/44 months after the first/second operation. Conclusion Repeated pancreatectomy should be performed for patients with pancreatodigestive anastomotic stricture to preserve remnant pancreatic function and for patients with neoplasm or pancreatic duct dilatation after PD for IPMN, and repeated pancreatectomy for recurrence of IDC might be indicated for selected patients.     

Ventral pancreatic resection for adenoma and low-grade malignancies of the head of the pancreas

The head of the pancreas can be anatomically divided into two sections, one drained by the duct of the Santorini system, and the other drained by the ventral pancreatic duct. This study was undertaken to determine whether independent resection of the ventral pancreas drained by the ventral pancreatic duct could be performed safely and effectively, by employing the following method in four patients. First, the duodenum and pancreas were sufficiently separated preserving the mesoduodenum and the posterior pancreaticoduodenal artery. Next, the main pancreatic duct was divided at the papillary portion, and sectioned at its junction with the duct of Santorini, ensuring preservation of the intrapancreatic bile duct. After the ventral pancreas had been detached from the glistening intrapancreatic bile duct, the ventral pancreas was connected with the dorsal pancreas by only the pancreatic parenchyma. The ventral pancreatic resection was completed following the incision of this border. A pancreatic fistula developed in one patient postoperatively, but this healed within 30 days. The hospital stay after surgery ranged from 35 to 58 days, and a good quality of life was maintained in all four patients. Thus, we conclude that ventral pancreatic resection can be safely performed and is especially valuable for treating the increasingly frequent adenomas and borderline malignancies in the main pancreatic duct system of the head of the pancreas.     

Demonstration of microcystic disease of the pancreas by magnetic resonance cholangiopancreatography: Report of a case

A case of microcystic disease of the pancreas which was clearly demonstrated by magnetic resonance cholangiopancreatography (MRCP) is reported herein. Cystic dilatation of the pancreatic duct was recognized by computed tomography scanning and endoscopic retrograde cholangiopancreatography (ERCP). Furthermore, the existence of microcystic clusters surrounding the dilated pancreatic duct were clearly visualized by MRCP. These microcystic clusters were strongly suspected preoperatively of having caused dilatation of the major pancreatic duct. Based on these findings, a distal pancreatectomy was performed. The operative specimen showed no accumulation of mucin and no evident lesions in the dilated pancreatic duct, being inconsistent with the entity of a mucus-producing tumor. Pathological examination revealed that the inner parts of microcysts constituted columnar epithelium with mucus production and papillary growth. Thus, a final histological diagnosis of intraductal papillary adenoma with idiopathic pancreatic duct ectasia was confirmed. In conclusion, MRCP, being a less aggressive diagnostic procedure than ERCP, proved extremely useful for obtaining precise information on cystic lesions of the pancreas in this patient.     

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??Associating partial pancreatectomy and extended extrahepatic bile duct resection VS. pancreatoduodenectomy for the middle cholangiocarcinoma involving the pancreas bile duct: clinical analysis of 41 cases YIN Lei* ,FANG Zheng,YUAN Bo, et al. *No.2 Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author:ZHANG Yong-jie, E-mail??510531179@qq.com
YIN Lei,FANG Zheng are the first authors who contributed equally to the article
Abstract Objective To compare the effect of associating partial pancreatectomy and extended extrahepatic bile duct resection with pancreaticoduodenectomy in the treatment of the middle cholangiocarcinoma involving the pancreas bile duct (MCIPB). Methods The clinical features, surgical methods and follow-up results of 41 patients with MCIPB were retrospectively analyzed from January 2010 to December 2015 in Eastern Hepatobiliary Surgery Hospital.Clinical factors that may affect the prognosis of the MCIPB were included in Kaplan-Meier analysis. Results Operations were performed in all 41 patients of MCIPB, including 23 patients of associating partial pancreatectomy and extended extrahepatic bile duct resection (APPER) and 18 patients of pancreaticoduodenectomy (PD), in which 5 were performed with pylorus-preserving pancreaticoduodenectomy (PPPD).The median survival time of the patients in the APPER group was 15 months, and the survival rate in 1, 3 and 5 years was 69.6%, 34.8% and 0% respectively.The median survival time in PD group was 21.5 months, and the survival rate in 1, 3 and 5 years was 55.5%, 33.3% and 22.2%, respectively.There was no statistically significant difference between the two groups (P=0.59).Multivariate analysis suggests that R1 resection was the only risk factor for survival. Conclusion APPER can obtain a certain clinical curative effect for part of MCIPB, but pancreatic-biliary surgeons should select suitable cases carefully.It is the key for APPER to ensure the negative margin.     

Surgical management of intraductal papillary mucinous tumors of the pancreas: the role of routine frozen section of the surgical margin, intraoperative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis.

HYPOTHESIS: Resection of intraductal papillary mucinous tumors of the pancreas (IPMTP) should be tailored to longitudinal spreading into the pancreatic ductal system and the presence of malignant transformation. OBJECTIVE: To review a single institutional experience with IPMTP, focusing on the operative strategy of tailoring resection to the extent of disease. DESIGN: Retrospective study. SETTING: Academic tertiary referral center. PATIENTS: Thirteen patients with IPMTP were referred for resection during the past 10 years. Malignant growth was present in 7 patients (54%). According to the determination of tumor extent, distal pancreatic resection was performed in 3 patients, pancreatoduodenectomy was done in 9 patients, and total pancreatectomy was performed in 1 patient. The median follow-up time in this series was 46 months (range, 3-104 months). MAIN OUTCOME MEASURES: Preoperative and perioperative diagnosis, final pathologic results, and long-term outcome. RESULTS: A correct preoperative or perioperative diagnosis of IPMTP was achieved in 9 patients (69%). Routine frozen section of the surgical margin was used in all patients, changing the operative strategy in 3 (23%) of 13 patients by extending resection or leading to total pancreatectomy in 2 patients and 1 patient, respectively. A perioperative endoscopic examination of the Wirsung duct was performed in 3 patients with a correct preoperative or perioperative diagnosis of IPMTP and a dilated pancreatic duct. This allowed the examination of the entire pancreatic ductal system and staged intraductal biopsies, changing the operative strategy in 1 of these patients. Finally, after pancreatoduodenectomy, pancreaticogastric anastomosis was constructed in 5 patients, allowing endoscopic assessment of the pancreatic stump during long-term follow-up. The 5-year actuarial survival rate was 56.8% in the whole series. All patients with benign or microinvasive malignant disease remained disease-free, whereas all patients with invasive malignant disease died of tumor recurrence. CONCLUSIONS: Accurate determination of the extent of ductal disease and residual malignant growth, when present, is critical during surgical exploration to achieve radical resection and cure. Operative strategy should be based on routine frozen section of the surgical margin and perioperative endoscopic examination of the Wirsung duct with staged intraductal biopsies when technically feasible. The routine use of pancreaticogastric anastomosis after pancreatoduodenectomy allows easy, safe, and efficient long-term endoscopic assessment of the pancreatic stump.     

侵及胰腺段胆管的中段胆管癌行联合部分胰腺切除的扩大肝外胆管切除与胰十二指肠切除疗效对比研究

目的 对比联合部分胰腺切除的扩大肝外胆管切除与胰十二指肠切除术治疗侵及胰腺段胆管的中段胆管癌（MCIPB）的疗效。方法 回顾性分析2010年1月至2015年12月海军军医大学东方肝胆外科医院收治的41例MCIPB病人的临床资料。选择对MCIPB预后可能产生影响的临床因素进行生存分析。结果 共41例MCIPB病人,其中行联合部分胰腺切除的扩大肝外胆管切除术（APPER）23例（APPER组）,全部行扩大肝外胆管切除+部分胰腺切除+No.8、9、12、13淋巴结清扫+肝总管空肠Roux-en-Y吻合;行胰十二指肠切除术（PD）18例（PD组）,其中5例行保留幽门的胰十二指肠切除术（PPPD）。APPER组病人中位生存时间为15个月,1、3、5年存活率分别为69.6%、34.8%及0;PD组病人中位生存时间为21.5个月,1、3、5年存活率分别为55.5%、33.3%及22.2%。两组总生存时间差异无统计学意义（P=0.59）。多因素分析显示,R1切除是影响生存的危险因素。结论 对于部分MCIPB病人,APPER可实现与PD同等疗效,但须谨慎挑选入选病例,术中多点取材保证阴性切缘是行APPER成功的关键。     

Pancreatic transection using ultrasonic dissector in pancreatoduodenectomy

BACKGROUND: Pancreatoenterostomic leakage after pancreatoduodenectomy may be caused partly by pancreatic juice leakage from transected branch pancreatic ducts on the pancreatic cut surface that do not drain into the main pancreatic duct after pancreatectomy. METHODS:We devised a new technique of pancreatic transection using an ultrasonic dissector followed by duct-to-mucosa pancreatojejunostomy, in order to prevent pancreatoenterostomic leakage after pancreatoduodenectomy in patients with a soft pancreas and a small main pancreatic duct. During pancreatic transection, branch pancreatic ducts and blood vessels are adequately skeletonized and securely ligated. The pancreatic duct is anastomosed to the full thickness of the jejunum with four to six interrupted sutures. RESULTS: Ten patients with a nondilated pancreatic duct (2 to 3 mm) underwent pancreatoduodenectomy by the present method. During pancreatic transection, 24 to 35 ducts including the pancreatic ducts and blood vessels were skeletonized and ligated. Postoperatively, no patients developed pancreatojejunostomic leakage. The present method may prevent pancreatoenterostomic leakage after pancreatoduodenectomy.     

Uncinatectomy: a novel surgical option for the management of intraductal papillary mucinous tumors of the pancreas

An intraductal papillary mucinous tumor (IPMT) is a rare cystic lesion of the pancreas, comprising only 1% of all pancreatic exocrine neoplasms. The prognosis for these lesions is typically favorable as compared with invasive ductal carcinomas. Nevertheless, the management of IPMTs involves surgical resection due to their malignant potential. When located in the pancreatic head, the conventional treatment for IPMT is pancreatoduodenectomy. Some authors have advocated limited pancreatectomy for low-grade IPMTs of the pancreas, thereby decreasing the morbidity of more extensive resection. In this report, we describe our technique of minimal pancreatectomy, whereby the uncinate process and associated branch duct were completely extirpated while preserving remainder of the pancreatic head, duodenum, and pancreatic ducts. The case presented underscores the feasibility and advantages of minimal pancreatic resection in the management of such tumors.     

Pancreatoduodenectomy with preservation of the pylorus and gastroduodenal artery.

OBJECTIVE: The authors evaluated the rationale for and feasibility of gastroduodenal artery preservation in pylorus-preserving pancreatoduodenectomy (PPPD) for periampullary cancer in which the pancreatic remnant maintains a normal function and morphologic characteristics. SUMMARY BACKGROUND DATA: Pylorus-preserving pancreatoduodenectomy has become one of the standard treatments used for benign and malignant diseases of the pancreatoduodenal region, surpassing ordinary pancreatoduodenectomy in terms of technical ease, mortality rate, and postoperative nutrition. Pylorus-preserving pancreatoduodenectomy is usually associated with gastroduodenal artery division, which presents potential risks of insufficient duodenal vascularity and lethal postoperative bleeding from the gastroduodenal artery stump. The latter complication particularly occurs after resection of bile duct or ampullary cancer in a patient whose pancreas remains functionally and morphologically normal to have much more pancreatic secretion than the fibrotic pancreas seen in pancreatic cancer. According to the authors data on the volume of secretion from the residual pancreas via a stent tube after pancreatoduodenectomy, the sclerotic pancreas, as seen in cancer of the pancreatic head, secrets only 20 to 50 mL/day, whereas the secretion from the soft pancreas, as seen in bile duct cancer, amounts to 300 to 600 mL/day, even during the period of nothing by mouth. METHODS: Retrospectively, we made a histopathologic study of eight specimens of distal bile duct and ampullary cancer resected by pancreatoduodenectomy or PPPD with gastroduodenal artery division. Prospectively, we performed gastroduodenal artery- preserving PPPD for 10 patients with distal bile duct, ampullary, and islet cell cancers. RESULTS: The histopathologic study revealed no invasion or metastasis around the gastroduodenal artery. Clinical application of gastroduodenal artery-preserving PPPD showed no technical difficulty, and neither severe complications nor recurrence around the gastroduodenal artery were observed for up to 22 months after surgery. CONCLUSIONS: Gastroduodenal artery- preserving PPPD might be recommended as a safe procedure for patients who have a functionally and morphologically normal pancreas.     

Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct.

Between 1946 and 1987, 647 patients with periampullary tumors were diagnosed at the University of Chicago Medical Center. These included 549 tumors located in the head of the pancreas, 40 in the distal common bile duct, 29 in the duodenum, and 29 at the ampulla of Vater. Ninety-eight per cent of all tumors were adenocarcinoma, with 93% of the remaining being duodenal carcinoid or sarcoma. Operability rate ranged from 81% to 97%, according to the tumor location and histologic type. A combination of laparotomy, biopsy, and bypass was performed in 433 patients and only one survived 5 years (0.2%). Resectability rate ranged from 16.5% for pancreatic adenocarcinoma to 89.3% for ampullary tumors. Of the 133 resections, 80 were pancreatoduodenectomies, 29 total pancreatectomies, 7 duodenectomies, 2 gastrectomies, 8 common bile duct resections, and 7 local excisions. Overall 19% of patients who underwent radical resection died in the immediate postoperative period, although mortality has decreased to 5% since 1981. Mortality was 20% after a standard pancreatoduodenectomy and 24.1% after a total pancreatectomy. Five-year actuarial survival rates, including perioperative deaths, were 8.8%, 20%, and 32% for pancreatic, duodenal, and ampullary adenocarcinoma, respectively. One half of patients with sarcoma and two-thirds with carcinoid of the duodenum survived 5 years. No patient with distal common bile duct adenocarcinoma achieved a 5-year survival rate. Multivariate analysis on all patients operated on (n = 566) revealed that the 5-year survival rate was significantly related to intent of operation (palliative 0.2%, curative 12%; p less than 0.001), histologic type (adenocarcinoma 2%, carcinoid and sarcoma 31%; p less than 0.0001), and site (ampullary and duodenal 21%, biliary and pancreatic 0.9%; p less than 0.001). A second multivariate analysis, evaluating only those patients with adenocarcinoma who survived the perioperative period of the radical resection (n = 97) analyzed the influence of tumor size and differentiation, lymphatic, capillary, and perineural microinvasion, lymph node status, and type of procedure (pancreatoduodenectomy vs. total pancreatectomy) on 5-year survival. None of these additional variables was significantly associated with long-term survival rates. In addition we evaluated the presence of local or distant recurrence after resection by analyzing the findings from all autopsies performed on these patients (n = 49): 29.4% of patients died with local recurrence alone, 23.5% with distant recurrence alone, and 47.1% had both local and distant recurrences.(ABSTRACT TRUNCATED AT 400 WORDS)     

Median pancreatectomy for tumors of the neck and body of the pancreas

Background: When enucleation is too risky because of possible damage of the main pancreatic duct, benign tumors located in the neck or body of the pancreas are usually removed by a left (spleno)-pancreatectomy or by a pancreatoduodenectomy. But standard pancreatic resection results in an important loss of normal pancreatic parenchyma and may cause impairment of exocrine and endocrine function. The aim of this study was to evaluate early and longterm results of median pancreatectomy, a limited resection of the midportion of the pancreas, in selected patients with benign or borderline tumors of the pancreas.

Study Design: Records of patients at Ospedale Busonera between November 1985 and September 1998 were reviewed. Ten patients with tumors of the neck or body of the pancreas underwent median pancreatectomy; the cephalic stump was sutured and the distal stump was anastomosed with a Roux-en-Y jejunal loop. Followup included clinical evaluation and routine laboratory tests: abdominal ultrasonography, exocrine and endocrine pancreatic function with fecal chymotrypsin, and an oral glucose tolerance test.

Results: Pathologic examination showed: insulinoma (n = 3), mucinous cystadenoma (n = 3), nonfunctioning endocrine tumor (n = 1), papillary-cystic neoplasm (n = 1), serous cystadenoma (n = 1), and intraductal mucinous tumor (n = 1). Operative mortality and morbidity were 0% and 40%, respectively; pancreatic fistula occurred in three patients. At mean followup of 62.7 months, no recurrence was found and no patient had exocrine insufficiency or glucose metabolism impairment.

Conclusions: Median pancreatectomy is a safe and effective alternative to major pancreatic resection in selected patients with benign or low-malignant lesions of the pancreas. This procedure carries a surgical risk similar to that of the standard operation, but avoids extensive pancreatic resection and pancreatic function impairment.     

Total splenopancreatectomy in the rat. Technical report

The techniques of total pancreatectomy previously described in the rat, separated the pancreatic lobules from their vascular and biliary connections. The technique described is an en bloc resection of the spleen, the pancreas, and the intrapancreatic common bile duct. The common bile duct is reimplanted in the duodenum by intubation, as described previously in liver transplants. This technique, performed in 12 rats, realised a more complete pancreatectomy than techniques described previously.     

Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 118 consecutive patients from a single center

Background/Purpose Appropriate surgical treatment strategies based on clinicopathological findings are unavailable for intraductal papillary mucinous neoplasm (IPMN) of the pancreas. We investigated the clinical features of pancreatic IPMN in a single-center database in order to design an optimal surgical strategy. Methods The medical records of 118 consecutive patients who had undergone surgical resection between August 1994 and December 2004, in whom IPMN was histologically confirmed, were reviewed retrospectively for radiological and pathological findings. Results Most of the invasive carcinomas in these patients were detected as the main-duct type (88.5%). The type of tumor (main-duct type vs branched-duct type), the tumor size, and the dilated duct size were significant predictive factors associated with malignancy. The relative risk of malignancy was greatest at 13-mm or more ductal dilation in the main-duct type (Odds ratio, 4.1), at 35-mm or more tumor size (Odds ratio, 7.6), and for main-duct type (Odds ratio, 3.9). Major pancreatic resections such as total pancreatectomy and pancreatoduodenectomy were performed in 14.5% and 69% of the patients, respectively. There was a 19.5% rate of incomplete resection, with these patients having a positive resection margin. However, significant recurrence did not occur in patients with a benign IPMN lesion which remained at the resection margin. The overall postoperative survival rate at 5 years was 98.2% for benign IPMN and 65.3% for malignant IPMN. Conclusions Function-preserving strategies, based on the clinical status of the patient, are necessary in order to avoid possible severe metabolic complications following extended pancreatectomy in patients with benign IPMN because of the low recurrence rate and good prognosis of this entity, irrespective of margin status.     

Histopathology in the evaluation of total pancreatectomy for ductal carcinoma.

Whipple resections for pancreatic head carcinoma are often inadequate because tumor is left behind in the body and tail. Thirty-six patients have undergone total pancreatectomy for various conditions, of which 25 have undergone total pancreatectomy, for ductal carcinoma. Thirty-seven per cent of these 25 patients have shown histologic evidence that a Whipple resection would not have adequately removed tumor-bearing pancreatic tissue. Three patients had carcinoma spreading up and along the common bile duct from a primary ductal carcinoma in the head of the pancreas. Four patients had tumor infiltrating in continuity into the pancreatic body and tail at a distance from the palpable tumore in the head well to the left of a Whipple transection site. Five patients had widespread multifocal autonomous tumor involving other areas in the gland but with tumor palpable only in the head of the pancreas. Three patients (12%) died postoperatively. The two year survival rate is 32%, and the five year survival, 19%. Histological factors affecting the survival prognosis include 1) positive nodes, 2) tumor extension up the common duct, and 3) intrapancreatic extension and multicentricity of tumor mandating total pancreatectomy for hope of cure in at least 38% of cases.     

Surgical treatment of benign and borderline neoplasms of the pancreatic body

BACKGROUND: Conventional operations for benign and borderline tumors of the pancreatic body are distal pancreatectomy and enucleation. An unusual operation allowing the preservation of the proximal and distal pancreas is median pancreatectomy. METHOD: A retrospective analysis of prospectively collected data on 67 patients with nonmalignant neoplasms of the pancreatic body was performed. The operations were: 32 median pancreatectomies (22 with duct occlusion of the distal pancreas, 10 with pancreaticojejunostomy), 21 distal pancreatectomies, and 14 enucleations. The operative and long-term outcomes of the different operations were compared. RESULTS: Enucleation had a shorter operative time and less blood loss than the other operations. No mortality was observed. The pancreatic fistula rate was 50% after median pancreatectomy (59% in case of distal duct occlusion, 30% in case of pancreaticojejunostomy), 14% after distal pancreatectomy and 14% after enucleation. Diabetes appeared in 3 patients after distal pancreatectomy and 3 patients after median pancreatectomy with duct occlusion. CONCLUSIONS: When indicated, enucleation is the operation of choice for a nonmalignant neoplasm of the pancreatic body. With respect to distal resection, the higher fistula rate of median pancreatectomy with pancreaticojejunostomy could be the price for a better long-term endocrine function; median pancreatectomy with duct occlusion had worse operative results and no long-term advantages.     

Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial

HYPOTHESIS: Prophylactic administration of octreotide acetate decreases the rate of postoperative intra-abdominal complications (IACs) after elective pancreatic resection. DESIGN: Single-blind, controlled, randomized trial. SETTING: Multicenter (N = 20) trial in France. PATIENTS: Of 230 randomized patients undergoing pancreatoduodenectomy and pancreatic enteric anastomosis or distal pancreatectomy for either malignant or benign tumor or chronic pancreatitis, 122 were allotted intraoperatively to receive octreotide; 108 served as controls. RESULTS: All 230 patients were analyzed. Both groups were comparable except that significantly more patients in the octreotide group had biological glue injected into the main pancreatic duct alone (P<.001) or reinforcing the pancreatic enteric anastomosis (68% [83/122] vs 39% [42/108]; P =.002). Fewer patients (P =.08) in the octreotide group sustained 1 or more IACs (22% vs 32%). In subgroup analysis, octreotide significantly reduced the rate of patients sustaining 1 or more IACs when the main pancreatic duct diameter was less than 3 mm (P<.02), when pancreatojejunostomy was performed (P<.02), or both (P<.02). No significant differences were found regarding IAC severity. Twenty-three patients (10%) died postoperatively, 16 (70% of deaths) of whom had 1 or more IACs. The only independent risk factor for IACs found on multivariate analysis was pancreatoduodenectomy compared with distal pancreatectomy (P<.01) (odds ratio, 3.54 [95% confidence interval, 1.44-8.65]). CONCLUSIONS: Our results suggest that octreotide is not necessary for all patients undergoing pancreatic resection; it could be useful when the main pancreatic duct is less than 3 mm in diameter and when pancreatoduodenectomy is completed by pancreatojejunostomy.     

磁共振胰胆管成像与经内镜逆行胰胆管造影对胆胰疾病诊断价值的比较研究

目的 评价磁共振胰胆管成像(MRCP)与经内镜逆行胰胆管造影(ERCP)对胆胰疾病的诊断价值.方法 对134例怀疑为胆胰管疾病病人行MRCP,并与58例ERCP比较,所有病例均经手术病理证实.结果 134例MRCP均获成功,在行ERCP中54例成功,4例失败者改行PTC检查成功.MRCP和ERCP总的诊断准确率分别为90.3%和88.9%.结论 MRCP对胆胰系统疾病中恶性梗阻所致的梗阻性黄疸诊断准确性较高,对胆总管、肝内胆管较小结石的诊断不如ERCP敏感及准确,而且不能治疗,提示MRCP和ERCP各有优越点,二者合理应用可提高胆胰系统疾病的诊断符合率.     

胰腺实性假乳头状瘤47例临床诊治分析

目的探讨胰腺实性假乳头状瘤（solid pseudopapillary tumor,SPT）的临床病理特征与诊断、治疗及预后。方法对2006年1月～2011年12月我院47例SPT的临床表现、实验室和影像学检查、病理结果、治疗和预后进行回顾性分析。结果 45例行手术切除,其中胰十二指肠切除术11例、胰体尾＋脾切除术18例、胰尾切除术2例、胰腺中段切除术3例、肿瘤局部切除术9例、术后复发再次手术2例;开腹探查术2例。术后出现胰漏14例,胆漏2例,出血3例,腹腔感染3例,胃瘫4例。45例术后随访3～68个月,平均32个月,其中随访〉24个月29例,均未出现复发和转移,无死亡。结论胰腺SPT是一种低度恶性肿瘤,临床表现无特异性,CT及MRI是最主要的影像学检查方法,治疗以手术切除为主,预后良好。     

Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results

Regional pancreatectomy refers to an en bloc removal of a tumor in or adjacent to the pancreas with an adequate soft tissue margin and with its regional lymphatic drainage. The pancreatic segment of portal vein is part of the en bloc resection with venous reconstruction by end-to-end anastomosis without a graft. This operation, called a Type I regional pancreatectomy, may utilize either a total or subtotal removal of the pancreas. Localized arterial involvement by a neoplasm necessitates adding a segmental resection of the artery with vascular reconstruction, a Type II procedure. Sixty-one patients have had this procedure from 1972 through 1982. They are a subset of the 270 patients with cancer of the pancreas, ampullary and periampullary regions, duodenum, or terminal portion of the common bile duct who were treated by the author during this period. The 61 consist of 35 patients who had an infiltrating duct adenocarcinoma of the pancreas and 21 who had other kinds of malignant tumors. In addition, four were classified as having pancreatitis and a fifth patient had a pseudolymphoma. The resectability rate is about 30%. The present operative mortality rate is 8%. Approximately one-third of the patients are alive; 43% of the 21 patients with malignant tumors other than infiltrating duct adenocarcinoma of the pancreas are alive with a median survival time of 40 months (3-92 months). Forty-three per cent were Stage I but more than half were T3 or T4 lesions. Twenty-five per cent of patients with Stages II or III are alive. Twenty per cent of patients with infiltrating duct carcinoma of the pancreas are presently alive, 28% died of recurrent disease, and 26% died of other causes; more than 90% of these patients had advanced stage disease (Stage II or III).     

胆肠胰结合部及其邻近区域外科手术的改进

目的: 总结几种胆肠胰部新型手术及其疗效 。方法及结果: 分析9例行胆肠胰部手术的特点及疗效。其中胰头部胰管及近邻手术3例;胆总管下端及壶腹部手术3例;十二指肠及近邻手术3例。根据各病例的病理及临床特点,设计并实施相应的新型手术方法,如胰头后侧径路主胰管切开取石术,胰头下部切除、钩突胰管空肠Roux-Y吻合术、经壶腹胆总管末端穿透伤直视下修补术、十二指肠节段切除术等,均获良好疗效 。结论: 本文介绍的新手术方法适合胆肠胰部的特殊病症,可有效预防胰、胆、十二指肠瘘等并发症。