Miyakawa Shuichi, Horiguchi Akihiko, Mizuno Kenji, Ishihara Shin, Niwamoto Naotatu, Miura Kaoru
Second Department of Gastroenterological Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutukake, Toyoake 470-11, Aichi, Japan.
Hepatogastroenterology. 2003 Jul-Aug;50(52):993-7.
Duodenum-preserving pancreatic head resection with preservation of the bile duct or without, has been performed in cases of benign or low-grade malignancies, such as intraductal papillary tumors, of the head of the pancreas. However, the selection of the patients, the area of resection in the head of the pancreas, and the operative procedures for the preservation of the pancreaticoduodenal vessels has not been realized among surgeons to apply duodenum-preserving pancreatic head resection as a radical treatment of intraductal papillary tumors. In our experience, duodenum-preserving pancreatic head resection can be applied in the majority of the patients with the branch type of intraductal papillary tumors, and it is necessary to resect completely the head of the pancreas to avoid tumor remnant and pancreatic fistula from the remaining pancreatic rim. Therefore, we modified it to include a total resection of the pancreatic head and the preservation of both anterior and posterior arterial arcades, due to the multiformity of the location of the tumor, the variation of the branch duct in the head of the pancreas, the closure of the minor papilla in some patients, and the unbalanced development of the arterial arcades of the pancreaticoduodenal region. We performed a duodenum-preserving total pancreatic head resection with preservation of the bile duct and the both anterior- and posterior-arterial arcades for 6 patients with the normal gland involving intraductal papillary tumors. The blood flow in this organ was based on the blood supply from both preserved arterial arcades, and the duodenum had retained good color, and the postoperative results were satisfactory.
保留十二指肠的胰头切除术，无论是否保留胆管，已应用于胰腺头部的良性或低度恶性肿瘤，如导管内乳头状肿瘤。然而，对于将保留十二指肠的胰头切除术作为导管内乳头状肿瘤的根治性治疗方法，外科医生尚未在患者选择、胰腺头部的切除范围以及保留胰十二指肠血管的手术操作等方面达成共识。根据我们的经验，保留十二指肠的胰头切除术可应用于大多数分支型导管内乳头状肿瘤患者，并且有必要完全切除胰头以避免肿瘤残留和剩余胰腺边缘出现胰瘘。因此，鉴于肿瘤位置的多样性、胰腺头部分支导管的变异、部分患者小乳头的闭合以及胰十二指肠区域动脉弓发育的不均衡，我们对该手术进行了改良，包括胰头全切除并保留前后动脉弓。我们对6例累及导管内乳头状肿瘤且腺体正常的患者实施了保留胆管及前后动脉弓的保留十二指肠胰头全切除术。该器官的血流基于保留的两个动脉弓的供血，十二指肠颜色保持良好，术后结果令人满意。
