Müller Michael W, Dahmen Rolf, Köninger Jörg, Michalski Christoph W, Hinz Ulf, Hartel Mark, Kadmon Martina, Kleeff Jörg, Büchler Markus W, Friess Helmut
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany.
Am J Surg. 2008 Jun;195(6):741-8. doi: 10.1016/j.amjsurg.2007.08.061. Epub 2008 Apr 23.
Duodenal adenomatosis is a premalignant condition often not treatable by local resection or endoscopy. An option for treatment is a pylorus-preserving (pp)-Whipple resection. Since the introduction of pancreas-preserving total duodenectomy (PPTD), the question has arisen whether a pp-Whipple resection is still needed to treat duodenal adenomatosis.
In a 5-year period 23 PPTDs were performed for duodenal adenomatosis. In a matched-pairs analysis the outcome following PPTD (16 patients with a follow-up longer than 12 months) was compared with pp-Whipple.
Hospital mortality in all 23 patients was 4.3% and total morbidity 30% after PPTD. Operation time, intensive care and hospital stay, morbidity, and mortality were comparable between the matched paired groups (16 patients). Patients with PPTD had significantly lower intraoperative blood loss. No PPTD patient required pancreatic enzyme substitution, compared with 12 patients after pp-Whipple. Quality-of-life analysis in PPTD patients revealed no difference compared to a normal control population and the pp-Whipple group.
PPTD is a safe surgical procedure for duodenal adenomatosis that avoids pancreatic head resection, provides high quality of life, and shows advantages over the pp-Whipple procedure.
十二指肠腺瘤病是一种癌前病变，通常无法通过局部切除或内镜治疗。一种治疗选择是保留幽门的（pp）-惠普尔切除术。自从引入保留胰腺的全十二指肠切除术（PPTD）以来，就出现了一个问题，即是否仍然需要pp-惠普尔切除术来治疗十二指肠腺瘤病。
在5年期间，对23例十二指肠腺瘤病患者进行了PPTD手术。在配对分析中，将PPTD术后的结果（16例随访时间超过12个月的患者）与pp-惠普尔手术的结果进行了比较。
23例患者中PPTD术后的医院死亡率为4.3%，总发病率为30%。配对组（16例患者）之间的手术时间、重症监护和住院时间、发病率和死亡率相当。PPTD患者的术中失血量明显较少。与pp-惠普尔手术后的12例患者相比，没有PPTD患者需要胰酶替代治疗。PPTD患者的生活质量分析显示与正常对照人群和pp-惠普尔组相比没有差异。
PPTD是一种治疗十二指肠腺瘤病的安全手术方法，可避免胰头切除，提供高质量生活，并且比pp-惠普尔手术具有优势。
