Chen Shi, Shen Bai-yong, Deng Xia-xing, Peng Cheng-hong
Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Zhonghua Wai Ke Za Zhi. 2010 Aug 15;48(16):1201-5.
To analyze the influence of pancreatic fistula in middle segmental pancreatic resection and summarize the experience in dealing with the stump.
The data of 40 cases undergoing middle pancreatectomy were reviewed retrospectively to analyze the curative effect and pancreatic fistula between April 2003 and December 2009. Of these, 36 patients with benign cases outcomes were compared with 2 separate control groups, 44 pancreaticoduodenectomy (PD) and 26 extended distal pancreatectomy (EDP).
The mean operating time of group MSP was 222 min, which was significantly shorter than that of group PD. The mean blood loss of group MSP was 316 ml, which was less than that of others. Otherwise, the postoperative nutritional status and blood sugar control in group MSP was superior to the other 2 groups. Through long-term follow-up, the patients in group MSP retained endocrine and exocrine function better. Only 1 patient developed new-onset diabetes mellitus after operation, and no patient required enzyme substitution. No lesion recurred. The rate of pancreatic fistula was highest (42%), but didn't result in the significant deference of overall discharge time with group PD and EDP. The pancreatic fistula level and the mean postoperative time in hospital didn't differ significantly from the other 2 groups.
Middle segmental pancreatectomy is a safe and feasible technique that is indicated for selected patients with benign or low malignant lesion in the neck and body of the pancreas. Though the rate of pancreatic fistula is higher, the risk of which is reduced by the marked curative effect. It is very important to deal with the stump reasonably.
分析中段胰腺切除术发生胰瘘的影响因素，并总结处理胰腺残端的经验。
回顾性分析2003年4月至2009年12月期间40例行中段胰腺切除术患者的资料，分析其疗效及胰瘘情况。其中36例良性病例的结局与2个单独的对照组进行比较，44例胰十二指肠切除术（PD）和26例扩大的远端胰腺切除术（EDP）。
中段胰腺切除术组的平均手术时间为222分钟，明显短于胰十二指肠切除术组。中段胰腺切除术组的平均失血量为316毫升，少于其他组。此外，中段胰腺切除术组术后营养状况和血糖控制优于其他2组。通过长期随访，中段胰腺切除术组患者的内分泌和外分泌功能保留得更好。术后仅1例患者出现新发糖尿病，无患者需要酶替代治疗。无病变复发。胰瘘发生率最高（42%），但与胰十二指肠切除术组和扩大的远端胰腺切除术组相比，总体出院时间无显著差异。胰瘘水平和术后平均住院时间与其他2组无显著差异。
中段胰腺切除术是一种安全可行的技术，适用于胰腺颈部和体部良性或低恶性病变的特定患者。尽管胰瘘发生率较高，但显著的疗效降低了其风险。合理处理胰腺残端非常重要。
