Dipartimento di Scienze Chirurgiche e Anestesiologiche, Chirurgia Generale-Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138 Bologna, Italy.
Updates Surg. 2010 Aug;62(1):41-6. doi: 10.1007/s13304-010-0005-z.
The aims of this study were to identify the indications to perform a total pancreatectomy and to evaluate the outcome and quality of life of the patient who underwent this operation. A retrospective analysis of a prospective database, regarding all the patients who underwent total pancreatectomy from January 2006 to June 2009, was carried out. Perioperative and outcome data were analyzed in two different groups: ductal adenocarcinoma (group 1) and non-ductal adenocarcinoma (group 2). Twenty (16.9%) total pancreatectomies out of 118 pancreatic resections were performed. Seven (35.0%) patients were affected by ductal adenocarcinoma (group 1) and the remaining 13 (65.0%) by pancreatic diseases different from ductal adenocarcinoma (group 2) [8 (61.5%) intraductal pancreatic mucinous neoplasms, 2 (15.4%) well-differentiated neuroendocrine carcinomas, 2 (15.4%) pancreatic metastases from renal cell cancer and, finally, 1 (7.7%) chronic pancreatitis]. Eleven patients (55%) underwent primary elective total pancreatectomy; nine (45%) had a completion pancreatectomy previous pancreaticoduodenectomy. Primary elective total pancreatectomy was significantly more frequent in group 2 than in group 1. Early and long-term postoperative results were good without significant difference between the two groups except for the disease-free survival that was significantly better in group 2. The follow-up examinations showed a good control of the apancreatic diabetes and of the exocrine insufficiency without differences between the two groups. In conclusion, currently, total pancreatectomy is a standardized and safe procedure that allows good early and late results. Its indications are increasing because of the more frequent diagnose of pancreatic disease that involved the whole gland as well as intraductal pancreatic mucinous neoplasm, neuroendocrine tumors and pancreatic metastases from renal cell cancer.
本研究的目的是确定行全胰切除术的适应证，并评估行此手术患者的结局和生活质量。对 2006 年 1 月至 2009 年 6 月期间行全胰切除术的所有患者的前瞻性数据库进行回顾性分析。在两组患者中分别分析围手术期和结局数据：导管腺癌（第 1 组）和非导管腺癌（第 2 组）。118 例胰腺切除术中，20 例（16.9%）行全胰切除术。7 例（35.0%）患者患有导管腺癌（第 1 组），其余 13 例（65.0%）患有非导管腺癌（第 2 组）[8 例（61.5%）胰管内黏液性胰腺肿瘤、2 例（15.4%）分化良好的神经内分泌癌、2 例（15.4%）肾细胞癌胰腺转移，最后 1 例（7.7%）慢性胰腺炎]。11 例（55%）患者行原发性择期全胰切除术；9 例（45%）患者行先前的胰十二指肠切除术，行补救性全胰切除术。原发性择期全胰切除术在第 2 组中比在第 1 组中更为常见。两组患者的早期和长期术后结果均良好，除无病生存率外，两组间无显著差异，第 2 组无病生存率明显更好。随访检查显示，两组患者的胰外分泌功能不全和糖尿病均得到良好控制，两组间无差异。总之，目前全胰切除术是一种标准且安全的手术，可获得良好的近期和远期效果。由于涉及整个腺体的胰腺疾病（包括胰管内黏液性胰腺肿瘤、神经内分泌肿瘤和肾细胞癌胰腺转移）的诊断越来越频繁，其适应证也在增加。
