摘要
背景保留十二指肠的胰头切除术是替代胰十二指肠切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的可行之选。方法检索Pubmed、Embase及Cochrane数据库中保留十二指肠胰头切除术的研究结果。根据手术指征、围手术期并发症及微创应用等纳入1994年1月至2021年3月的38项队列研究共702例患者的临床资料。结果共702例患者分别因良性肿瘤、癌前病变、囊性肿瘤、胰腺神经内分泌肿瘤、十二指肠乳头周围腺瘤等行保留十二指肠的胰头切除术。702例患者中,214例(30.5%)行保留十二指肠的部分胰头切除术,488例(69.5%)行保留十二指肠的全胰头切除术,后者中微创手术占17.3%。两种术式的术后早期严重并发症发生率(术后B及C级胰瘘、胆瘘、腹腔出血及腹腔脓肿)均<10%,围手术期病死率分别为0和1.02%。经中位时间为(50.7±21.1)个月的随访,局部复发率为2.8%(15/404)。结论保留十二指肠的胰头切除术应作为胰头部分支胰管型导管内乳头状肿瘤、实性假乳头状肿瘤、黏液性囊腺瘤、>2 cm的有或无功能的良性内分泌肿瘤外科治疗的首选术式。
Background Duodenum-preserving pancreatic head resections(DPPHR)for benign,cystic neoplasms and neuroendocrine adenomas are alternative treatment principles to pancreatoduodenectomy.Methods Pubmed,Embase,and Cochrane Libraries were searched for studies reporting results following duodenum-preserving pancreatic head resection.Between 1994 and 3/2021,38 cohort studies,comprising data of 702 patients were analysed regarding indication to surgery and early postoperative outcome and application of minimally invasive approach.Results A total of 702 patients underwent DPPHR for benign tumors,premalignant,cystic neoplasms,pancreatic neuroendocrine tumors(PNETs)and peripapillary adenomas.Of 702 patients,214 patients underwent partial(30.5%)and 488 patients a total DPPHR(69.5%).In 488 patients,who had total DPPHR,a minimally invasive approach was used in 17.3%.The frequency of severe,early postoperative complications(postoperative pancreatic fistula B+C,biliary fistula,intraabdominal haemorrhage,and intraabdominal abscess)was below 10%.The in-hospital mortality for partial DPPHR was 0,for total DPHHR 1.02%.After a mean follow-up of 50.7±21.1 months,the frequency of local recurrence was 2.8%(15/404).Conclusion DPPHR should be considered as first choice surgical treatment for branch-duct intraductal papillary mucinous neoplasms,solid pseudopapillary neoplasm,mucinous cystic neoplasm,and for benign,functional and non-functional PNETs larger than 2 cm of the pancreatic head.
作者
Hans G.Beger
Benjamin Mayer
Yinmo Yang
Bertram Poch
Hans G.Beger;Benjamin Mayer;Yinmo Yang;Bertram Poch(c/o University of Ulm,Albert-Einstein-Allee 23,89081 Ulm,Germany;Institute for Epidemiology and Medical Biometry,University of Ulm,Germany;Department of Surgery,Peking University First Hospital,Beijing 100034,China;Center for Oncologic,Endocrine and Minimal Invasive Surgery,Donau-Klinikum Neu-Ulm,Germany)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第7期608-617,共10页
Chinese Journal of Surgery
关键词
胰腺肿瘤
外科手术
系统分析
Pancreatic neoplasms
Surgical procedures,operative
Overview
