Takada Tadahiro, Yasuda Hideki, Amano Hodaka, Yoshida Masahiro
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
J Gastrointest Surg. 2004 Feb;8(2):220-4. doi: 10.1016/j.gassur.2003.11.007.
A duodenum-preserving pancreatic head resection technique was first reported in 1980, but the indications have been limited to benign pancreatic disease as it involves a subtotal pancreatic head resection. In 1988 we detailed a duodenum-preserving total pancreatic head resection (DPTPHR) technique. This procedure involved a total pancreatic head resection and as such expanded the indications for this approach to include tumorigenic masses. The original method involved closure of the proximal pancreatic duct and an anastomosis of the pancreatic duct of the distal pancreas to a newly created small hole in the duodenum (we termed this a "pancreatoduodenostomy"). Our current technique involves a duct-to-duct anastomosis of the proximal pancreatic duct and the distal pancreas to better preserve anatomic structure. DPTPHR was performed in 26 patients from 1988 to 2002, including 12 cases of DPTPHR with pancreatoduodenostomy and 14 cases of DPTPHR with pancreatic duct-to-duct anastomosis. No differences were observed between the two methods with respect to operative time or blood loss during surgery. Postoperatively, there was one case of cholecystitis and one case of pancreatitis in a patient who underwent a pancreatoduodenostomy; both of these patients were treated conservatively with curative intent. No complications were observed in the group undergoing duct-to-duct anastomosis. The advantage of duct-to-duct anastomosis is that the pancreatic head is totally resected, thus allowing removal of neoplastic disease such as an intraductal papillary mucinous tumor and also therapy for chronic pancreatitis. A key benefit of this procedure is that sphincter function of the duodenal papilla is preserved permitting drainage of pancreatic/bile juice into the duodenum, preserving a more physiologic state than is the case after a pancreatoduodenostomy.
保留十二指肠的胰头切除术技术于1980年首次报道，但由于该技术涉及胰头次全切除，其适应证一直局限于良性胰腺疾病。1988年，我们详细阐述了保留十二指肠的全胰头切除术（DPTPHR）技术。该手术包括全胰头切除，因此扩大了该方法的适应证，使其包括致瘤性肿块。最初的方法是封闭近端胰管，并将远端胰腺的胰管与十二指肠上新造的小孔进行吻合（我们将此称为“胰十二指肠吻合术”）。我们目前的技术是将近端胰管与远端胰腺进行胰管对胰管吻合，以更好地保留解剖结构。1988年至2002年期间，对26例患者实施了DPTPHR，其中12例采用胰十二指肠吻合术的DPTPHR，14例采用胰管对胰管吻合术的DPTPHR。两种方法在手术时间或术中失血方面未观察到差异。术后，接受胰十二指肠吻合术的患者中有1例发生胆囊炎，1例发生胰腺炎；这两名患者均以治愈为目的进行了保守治疗。接受胰管对胰管吻合术的组未观察到并发症。胰管对胰管吻合术的优点是胰头被完全切除，从而能够切除诸如导管内乳头状黏液性肿瘤等肿瘤性疾病，也能治疗慢性胰腺炎。该手术的一个关键益处是保留了十二指肠乳头的括约肌功能，使胰液/胆汁能够排入十二指肠，与胰十二指肠吻合术后相比，保留了更接近生理状态的情况。
