Oida Yasuhisa, Imaizumi Toshihide, Dowaki Shoichi, Tobita Kosuke, Ohtani Yasuo, Mukai Masaya, Makuuchi Hiroyasu
Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan.
Hepatogastroenterology. 2007 Jun;54(76):1266-8.
Reconstruction by pancreaticoenterostomy has generally been employed after medial pancreatectomy for tumor. As a less invasive procedure, here we report three patients who successfully underwent pancreatic end-to-end anastomosis after medial pancreatectomy. The subjects consisted of 2 patients with serous cystadenomas and 1 patient with an intraductal papillary mucinous tumor. These tumors were detected in the pancreatic neck or body, and the maximal tumor diameters ranged from 10 to 33mm. The pancreatic duct diameters were 2 mm in 2 patients and 4 mm in 1 patient. The procedure was carried out by ductal anastomosis and parenchymal anastomosis with interrupted sutures. A pancreatic tube was inserted for decompression at the anastomotic site in all patients. The mean operative time was 3 hours and 31 minutes, and the intraoperative blood loss was 428 mL. Although pancreatic fistula was observed in 2 patients with the normal pancreas, conservative therapy relieved this complication. Neither tumor relapse nor stenosis of the pancreatic duct at the anastomotic site was detected in any patient, with a follow-up of 4 to 27 months. Our experience confirmed that in selected cases, this reconstructive procedure was feasible and safe for physiological reconstruction without involvement of the digestive tract.
对于肿瘤行胰中段切除术后，一般采用胰肠吻合术进行重建。作为一种侵入性较小的手术，我们在此报告3例患者在胰中段切除术后成功进行了胰端端吻合术。病例包括2例浆液性囊腺瘤患者和1例导管内乳头状黏液性肿瘤患者。这些肿瘤位于胰颈或胰体部，最大肿瘤直径为10至33毫米。2例患者的胰管直径为2毫米，1例患者为4毫米。手术通过导管吻合和实质吻合并间断缝合完成。所有患者均在吻合部位插入胰管进行减压。平均手术时间为3小时31分钟，术中失血量为428毫升。虽然2例胰腺正常的患者出现了胰瘘，但保守治疗缓解了这一并发症。在4至27个月的随访中，未发现任何患者有肿瘤复发或吻合部位胰管狭窄的情况。我们的经验证实，在选定的病例中，这种重建手术对于不涉及消化道的生理性重建是可行且安全的。
