Efron David T, Lillemoe Keith D, Cameron John L, Yeo Charles J
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
J Gastrointest Surg. 2004 Jul-Aug;8(5):532-8. doi: 10.1016/j.gassur.2004.03.004.
Benign lesions of the neck and proximal body of the pancreas pose an interesting surgical challenge. If the lesions are not amenable to simple enucleation, surgeons may be faced with the choice of performing a right-sided resection (pancreaticoduodenectomy) or a left-sided resection (distal pancreatectomy) to include the lesion, resulting in resection of a substantial amount of normal pancreatic parenchyma. Central pancreatic resection has been reported with Roux-en-Y pancreaticojejunostomy reconstruction; however, this interrupts small bowel continuity and obligates an additional anastomosis. We have reviewed our experience with central pancreatectomy with pancreaticogastrostomy (PG) for benign central pancreatic pathology. Between January 1999 and December 2002, 14 central pancreatectomies were performed with PG reconstruction. There were 7 women and 7 men with a mean age of 60.9 years. Five resections were performed for islet cell tumors, three were performed for noninvasive intraductal papillary mucinous neoplasms, two were performed for serous cystadenoma, and one each was performed for a simple cyst, pseudocyst, mucinous metaplasia, and focal chronic pancreatitis. Seven out of 14 patients experienced a total of 10 complications. Pancreatic fistulae manifested by drainage of amylase-rich fluid from the operatively placed drains developed in 5 patients (36%). Reoperation or interventional radiologic procedures were not required in any patient with a fistula. Postoperative follow-up demonstrated 13 out of 14 patients to be alive and well without evidence of pancreatic insufficiency. One patient died at home on postoperative day 57 of cardiac pathology. Central pancreatectomy with PG is a safe and effective procedure that allows for preservation of pancreatic endocrine and exocrine function without disruption of enteric continuity. The complication of pancreatic fistula was managed conservatively via maintenance of operatively placed drains.
胰腺颈部和近端体部的良性病变给外科手术带来了有趣的挑战。如果病变不适合简单摘除，外科医生可能会面临选择进行右侧切除术（胰十二指肠切除术）或左侧切除术（远端胰腺切除术）以切除病变，这会导致大量正常胰腺实质被切除。已有报道采用 Roux-en-Y 胰空肠吻合术重建进行中央胰腺切除术；然而，这会中断小肠连续性并需要额外进行吻合。我们回顾了我们采用胰胃吻合术（PG）进行中央胰腺切除术治疗良性中央胰腺病变的经验。在 1999 年 1 月至 2002 年 12 月期间，共进行了 14 例采用 PG 重建的中央胰腺切除术。患者中有 7 名女性和 7 名男性，平均年龄为 60.9 岁。5 例切除是针对胰岛细胞瘤，3 例是针对非侵袭性导管内乳头状黏液性肿瘤，2 例是针对浆液性囊腺瘤，1 例分别针对单纯囊肿、假性囊肿、黏液化生和局灶性慢性胰腺炎。14 名患者中有 7 名共经历了 10 次并发症。5 名患者（36%）出现了胰瘘，表现为从手术放置的引流管引出富含淀粉酶的液体。任何有胰瘘的患者均无需再次手术或介入放射学操作。术后随访显示，14 名患者中有 13 名存活且状况良好，无胰腺功能不全的证据。1 名患者在术后第 57 天因心脏病变在家中死亡。采用 PG 的中央胰腺切除术是一种安全有效的手术方法，可保留胰腺内分泌和外分泌功能，且不破坏肠道连续性。胰瘘并发症通过维持手术放置的引流管进行保守处理。
