Xiang Guang-ming, Tan Chun-lu, Zhang Hao, Ran Xun, Mai Gang, Liu Xu-bao
Department of Hepatobiliopancreatic Surgery, Sichuan University, Sichuan Province, China.
Hepatogastroenterology. 2012 Jun;59(116):1286-9. doi: 10.5754/hge11937.
BACKGROUND/AIMS: To investigate the effectiveness and safety of central pancreatectomy.
We retrospectively studied 44 cases that underwent central pancreatectomy (CP), 55 patients who underwent distal pancreatectomy (DP), and 62 patients who underwent pancreatoduodenectomy (PD) for their benign or borderline pancreatic lesions; as well as the different management styles for pancreatic stumps in CP.
The duration of surgery and length of hospital stay were shorter in the CP group than that of PD group, and blood loss was also less in CP group. There were no differences between the CP and DP groups in duration of surgery, length of hospital stay, and blood loss. The incidence of common surgical complications was higher in the PD group. There were more pancreatic fistulas (grade B/C) in CP and PD groups compared to that of the DP group. New onset or worsening of diabetes occurred only in the CP and PD groups at 4.8% and 10.9%, respectively. A pancreaticogastrostomy for distal pancreatic stumps reduced the incidence of pancreatic fistula (p=0.038). Duct-to-mucosa anastomosis had less pancreatic fistula than invagination anastomosis (p=0.017). There was no difference in incidence of pancreatic fistula between pancreaticojejunostomy and oversewing of proximal pancreatic stumps (p=0.601).
CP is an available and safe operation for benign or borderline lesions located in the pancreatic neck. A pancreaticogastrostomy for distal pancreatic stumps or duct-to-mucosa anastomosis may reduce the risk of pancreatic fistula.
背景/目的：探讨全胰切除术的有效性和安全性。
我们回顾性研究了44例行全胰切除术（CP）、55例行胰体尾切除术（DP）以及62例行胰十二指肠切除术（PD）的患者，这些患者均患有良性或交界性胰腺病变；同时还研究了CP术中胰腺残端的不同处理方式。
CP组的手术时间和住院时间均短于PD组，且CP组的失血量也更少。CP组和DP组在手术时间、住院时间和失血量方面无差异。PD组常见手术并发症的发生率更高。与DP组相比，CP组和PD组的胰瘘（B/C级）更多。新发糖尿病或糖尿病恶化仅发生在CP组和PD组，发生率分别为4.8%和10.9%。远端胰腺残端行胰胃吻合术可降低胰瘘的发生率（p = 0.038）。导管对黏膜吻合术的胰瘘发生率低于内翻吻合术（p = 0.017）。胰空肠吻合术与近端胰腺残端缝合术的胰瘘发生率无差异（p = 0.601）。
CP对于位于胰腺颈部的良性或交界性病变是一种可行且安全的手术方式。远端胰腺残端行胰胃吻合术或导管对黏膜吻合术可降低胰瘘风险。
