胰体肿瘤的逆行性胰体尾切除术.DOCVIP

临床医学论文-胰体肿瘤的逆行性胰体尾切除术 ???????????? 作者：葛春林 郭克建 郭仁宣 田雨霖 【摘要】? 目的 探讨胰体肿瘤行先切断胰颈的逆行性胰体尾切除方法的可行性。方法 回顾性分析我院2001-2006年行逆行性胰体尾切除术9例患者的临床资料。结果 所有患者均成功完成逆行性胰体尾切除术，平均手术时间(145±72)min，术中平均出血220 ml，均未输血，患者术后恢复良好，术后平均住院时间(12±4.3)d，无胰漏及其他并发症发生。无新发糖尿病病例。对所有患者随访(3～57个月)，有2例分别存活14个月和33个月，其余患者健在。结论 该方法易显露门静脉和肠系膜上静脉，避免了术中门静脉、肠系膜上静脉损伤的风险。先阻断胰体尾脾的主要血供，减少了出血量，降低了手术难度，缩短了手术时间。 【关键词】? 胰体尾切除术； 逆行性； 胰腺肿瘤 ??? 【Abstract】? Objective? To explore the feasibility of retrograde distal pancreatectomy starting from the neck of the pancreas in the treatment of pancreas tumor. Methods?The clinical data and operation methods of 9 patients undergoing retrograde distal pancreatectomy from 2001 to 2006 were evaluated.Results?The body and tail of pancreas of all the patients were dissected successfully by retrograde distal pancreatectomy with average operation time and operative hemorrhage of (145?2) minutes and 220 ml respectively. All patients recovered well after operation, with average postoperative stay of (12?.3) days. No fistula, diabetes or other complication occurred. All the patients were followed up for 357 months and lived well, except for 2 who only survived for 14 months and 33 months respectively.? Conclusions? The method can easily expose the portal vein and superior mesenteric vein, which decreases the risk of injuring portal vein and superior mesenteric vein during the operation. The blockage of major circulation of the spleen and the body and tail of pancreas reduces the operative hemorrhage, difficulty of the operation and shortens the operation time as well. ??? 【Key words】? Distal pancreatectomy;? Retrograde;? Pancreas tumor ??? 胰体尾部切除的标准术式是游离脾及胰腺的上下缘，然后将脾及胰体尾翻向右上方，于胰体部预定切断线的近端分离出脾动静脉，结扎切断，切除脾和胰体尾部。但有些胰体肿瘤与肠系膜上静脉关系密切，已侵及脾动静脉根部，常规方法难以切除，容易损伤肠系膜上静脉和脾动静脉。近5年，我们用首先切断胰颈的逆行胰体尾切除方法对9例患者进行了手术，取得了良好效果。 ??? 1? 资料和方法 ??? 1.1? 一般资料 ??? 2001-2006年中国医科大学附属第一医院共进行了9例逆行性胰体尾切除术，其中男3例，女6例； 平均年龄52.6岁 (42～64岁)。患者的具体情况见表1。9例患者中3例合并糖尿病。 ??? 1.2? 手术方式 ??? 采用上腹部弧形切口，必要时附加剑突下正中的切口。首先探查有无腹水、腹膜及腹腔脏器种植和转移，有无淋