Gloor B, Friess H, Uhl W, Büchler M W
Department of Visceral and Transplant Surgery, University of Bern, Inselspital, Bern, Switzerland.
Dig Surg. 2001;18(1):21-5. doi: 10.1159/000050092.
Resection of the pancreas requires control of tributaries of the superior mesenteric vein (SMV) inferior to the head of the pancreas as well as separation of the posterior surface of the pancreas from the SMV and from eventually existing collateral veins. This usually is the most tedious part when performing a resection of the pancreatic head, in particular if there are signs of portal hypertension. Portal vein pathology contributes to intra- and postoperative morbidity in pancreatic surgery.
Instead of dissecting the pancreas along the anterior surface of the SMV our proposed technique allows resection of the head of the pancreas without division of the gland. This approach combines elements of Beger's duodenum-preserving pancreatic head resection and of Frey's limited local pancreatic head excision combined with a longitudinal pancreaticojejunostomy. This modified technique avoids the risk of a bleeding complication which is increased in the presence of portal hypertension and dilation.
The advantages of this modified technique over standard Beger and Frey procedures are: (1) the minimized risk of a bleeding complication in case of portal hypertension because pancreatic transsection does not need to be done, and (2) the considerably more radical excision as compared to local excision. Also, it represents the most minimal surgical trauma for resecting the head of the pancreas as compared to other commonly used techniques.
胰腺切除术需要控制胰腺头部下方的肠系膜上静脉（SMV）分支，以及将胰腺后表面与SMV和最终存在的侧支静脉分离。在进行胰头切除时，这通常是最繁琐的部分，特别是在存在门静脉高压迹象的情况下。门静脉病变会导致胰腺手术的术中及术后发病率增加。
我们提出的技术不是沿着SMV前表面解剖胰腺，而是允许在不分割腺体的情况下切除胰头。这种方法结合了保留十二指肠的Beger胰头切除术和Frey有限局部胰头切除术的要素，并结合了纵向胰空肠吻合术。这种改良技术避免了在门静脉高压和扩张情况下出血并发症风险增加的问题。
这种改良技术相对于标准的Beger和Frey手术的优点是：（1）在门静脉高压情况下出血并发症风险最小化，因为不需要进行胰腺横断；（2）与局部切除相比，切除更为彻底。此外，与其他常用技术相比，它是切除胰头时手术创伤最小的方法。
