摘要
目的为中段胰腺切除术在胰腺实性假乳头状瘤治疗中的合理应用提供一定依据。方法回顾性分析2010年1月至2015年12月在海军军医大学附属长海医院接受胰腺手术的患者临床病例资料,筛选病理结果为实性假乳头状瘤且肿瘤位于胰腺颈部或近体部的病例。根据手术方案分为中段胰腺切除术组(central pancreatectomy,CP)和远端胰腺切除术组(distal pancreatectomy,DP),比较两组患者的术中情况、术后并发症发生率及复发率情况。结果共37例患者入组,其中CP组12例,DP组25例。两组在手术时间[(119.92±29.56)min vs(100.92±27.91)min,t=1.902,P=0.065]、术中失血量[(291.67±178.16)mL vs(330.00±277.26)mL,t=-0.436,P=0.666]、住院时间[(14.5±4.3)d vs(13.24±4.9)d,t=0.759,P=0.451]等方面差异均无统计学意义。在术后并发症方面,两组胰瘘、出血、腹腔感染、胃排空障碍发生率均无统计学差异(P>0.05);在术后内发泌功能不全(新发糖尿病)(9.1%vs 28.6%,P=0.374)、外分泌功能不全(0 vs 14.3%,P=0.534)方面两组虽存在差异,但也无统计学意义。两组均无围手术期死亡病例,随访期内无复发病例。结论与传统术式DP治疗胰颈部或近体部胰腺实性假乳头状瘤相比,CP手术未增加术后并发症发生率,且在一定程度上降低了发生外分泌功能不全的风险,选用适宜的残端处理方法可有效控制CP手术后的胰瘘发生率。
Objective To provide a basis for reasonable application of central pancreatectomy(CP)in treatment of solid pseudopapillary neoplasm of the pancreas(SPNP).Methods The clinicopathological data of patients underwent pancreatic surgery in Changhai Hospital Affiliated to Naval Military Medical University from Jan.2010 to Dec.2015 were retrospectively analyzed,and the cases with SPNP that located in the neck or proximal body of pancreas were retrieved.The cases were divided into CP group and the DP(distal pancreatectomy)group.Then intraoperative data and postoperative complications and recurrence rate were compared between the two groups.Results A total of 37 patients were enrolled,including 12 in CP group and 25 in DP group.There was no significant difference between the two groups in terms of operation time[(119.92±29.56)min vs(100.92±27.91)min,t=1.902,P=0.065],blood loss[(291.67±178.16)mL vs(330.00±277.26)mL,t=-0.436,P=0.666]or hospitalization time[(14.5±4.3)d vs(13.24±4.9)d,t=0.759,P=0.451].There was no significant difference between the two groups in terms of pancreatic fistula,hemorrhage,abdominal infection,or delayed gastric emptying.There were differences in the incidence of new onset diabetes melitus(9.1%vs 28.6%,P=0.374)and pancreatic exocrine insufficiency(0 vs 14.3%,P=0.534)between the two groups,but there was no statistical significance(P>0.05).There was no perioperative death in either group.Conclusion Compared with DP in treatment of solid pseudopapilloma of the neck or proximal body of the pancreas,CP reduces the risk of exocrine dysfunction to a certain extent,without increasing the incidence of postoperative complications.The incidence of pancreatic fistula after CP can be effectively controlled by appropriate treatment of the stump.
作者
李森
李炜
杨佳华
程鹏
陈诚
于昆
吴文韬
李刚
LI Sen;LI Wei;YANG Jia-hua;CHENG Peng;CHEN Cheng;YU Kun;WU Wen-tao;LI Gang(Department of General Surgery,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China;Department of Hepatobiliary,Pancreatic and Splenic Surgery,Changhai Hospital,Naval Military Medical University,Shanghai 200433,China)
出处
《肝胆胰外科杂志》
CAS
2021年第5期263-268,共6页
Journal of Hepatopancreatobiliary Surgery
基金
普陀区临床特色专病能力提升项目(2020tszb03)
上海市医学重点专科建设项目(ZK2019B18)。
关键词
胰腺实性假乳头瘤
中段胰腺切除术
远端胰腺切除术
胰腺功能不全
术后并发症
solid pseudopapillary neoplasm of the pancreas
central pancreatectomy
distal pancreatectomy
pancreatic insufficiency
postoperative complication
