Glanemann Matthias, Shi Baomin, Liang Feng, Sun Xiao-Gang, Bahra Marcus, Jacob Dietmar, Neumann Ulf, Neuhaus Peter
Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Germany.
World J Surg Oncol. 2008 Nov 12;6:123. doi: 10.1186/1477-7819-6-123.
Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the above mentioned topics.
近年来，肿瘤相关的胰腺手术取得了显著进展。胰十二指肠切除术（PD）联合淋巴结清扫术，包括血管切除，仍然是治疗胰头癌的最佳手术方式。对于患有小肿瘤或低级别恶性肿瘤的患者，以及位于胰腺中部的小胰腺转移瘤，保留幽门的胰十二指肠切除术（PPPD）正在成为一种安全有效的选择，发生新发外分泌和/或内分泌功能不全的风险较低。全胰切除术（TP）不像几年前那样风险高，如今可以安全地进行，但它的适应症仅限于无法通过PD或远端胰腺切除术（DP）获得无瘤手术切缘的局部进展期肿瘤。因此，TP尚未被大多数外科医生作为常规手术采用。另一方面，对于晚期远端胰腺肿瘤，在有安全且经验丰富的手术条件下，需要采取积极的态度。由于现代器械的发展，腹腔镜手术越来越成功，即使在恶性胰腺疾病中也是如此。本综述总结了关于上述主题的最新文献。
