Yamaguchi K, Shimizu S, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M
First Department of Surgery, Kyushu University Faculty of Medicine, Fukuoka 812-8582, Japan.
J Hepatobiliary Pancreat Surg. 1999;6(1):69-73. doi: 10.1007/s005340050085.
Two patients with intraductal papillary-mucinous adenoma of the pancreas were successfully treated by ductal branch-oriented minimal pancreatectomy. We propose this novel less invasive ductal branch-oriented pancreatectomy, as indicated for benign ductal ectasia of the pancreas. The cystically dilated branch duct is identified by intraoperative ultrasonography, intraoperative balloon pancreatography, and injection of indigocarmine into the cyst. The cystically dilated branch is resected from the surrounding pancreas together with minimal removal of the pancreatic parenchyma. The communicating duct and cutting margins are tightly ligated to prevent pancreatic juice leakage and fistula. A drainage tube is placed in the main pancreatic duct whenever possible. Histopathologic examination of the transected branch duct is necessary to check for mucosal extension of dysplastic epithelium. This ductal branch-oriented minimal pancreatectomy is the least invasive pancreatectomy and a suitable operation for branch-type ductal ectasia of the pancreas, which is usually benign.
两名胰腺导管内乳头状黏液性腺瘤患者通过导管分支导向的微创胰腺切除术成功治愈。我们提出这种新型的、侵入性较小的导管分支导向胰腺切除术，适用于胰腺良性导管扩张。术中超声、术中球囊胰管造影以及向囊肿内注射靛胭脂可识别囊状扩张的分支导管。将囊状扩张的分支连同最少的胰腺实质一并从周围胰腺切除。对连通导管和切缘进行紧密结扎以防止胰液漏出和形成瘘管。尽可能在主胰管内放置引流管。对横断的分支导管进行组织病理学检查，以检查发育异常上皮的黏膜延伸情况。这种导管分支导向的微创胰腺切除术是侵入性最小的胰腺切除术，是适合通常为良性的胰腺分支型导管扩张的手术。
