c/o Klinikum, University of Ulm, Ulm, Germany.
J Gastrointest Surg. 2012 Nov;16(11):2160-6. doi: 10.1007/s11605-012-1929-z. Epub 2012 Jul 12.
Cystic neoplasms of the pancreas are diagnosed frequently due to early use of abdominal imaging techniques. Intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and serous pseudopapillary neoplasia are considered pre-cancerous lesions because of frequent transformation to cancer. Complete surgical resection of the benign lesion is a pancreatic cancer preventive treatment.
The application for a limited surgical resection for the benign lesions is increasingly used to reduce the surgical trauma with a short- and long-term benefit compared to major surgical procedures. Duodenum-preserving total pancreatic head resection introduced for inflammatory tumors in the pancreatic head transfers to the patient with a benign cystic lesion located in the pancreatic head, the advantages of a minimalized surgical treatment.
Based on the experience of 17 patients treated for cystic neoplastic lesions with duodenum-preserving total pancreatic head resection, the surgical technique of total pancreatic head resection for adenoma, borderline tumors, and carcinoma in situ of cystic neoplasm is presented. A segmental resection of the peripapillary duodenum is recommended in case of suspected tissue ischemia of the peripapillary duodenum. In 305 patients, collected from the literature by PubMed search, in about 40% of the patients a segmental resection of the duodenum and 60% a duodenum and common bile duct-preserving total pancreatic head resection has been performed.
Hospital mortality of the 17 patients was 0%. In 305 patients collected, the hospital mortality was 0.65%, 13.2% experienced a delay of gastric emptying and a pancreatic fistula in 18.2%. Recurrence of the disease was 1.5%. Thirty-two of 175 patients had carcinoma in situ.
Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions is a safe surgical procedure with low post-operative morbidity and mortality.
由于腹部影像学技术的早期应用，胰腺囊性肿瘤的诊断变得更加频繁。由于经常向癌症转化，导管内乳头状黏液性肿瘤、黏液性囊腺瘤和浆液性假乳头状肿瘤被认为是癌前病变。良性病变的完全手术切除是一种预防胰腺癌的治疗方法。
对于良性病变，应用有限的手术切除来减少手术创伤，与主要手术程序相比具有短期和长期的益处。保留十二指肠的全胰头切除术最初用于胰腺头部的炎性肿瘤，现已转移到胰腺头部有良性囊性病变的患者，该手术具有微创治疗的优势。
基于 17 例接受保留十二指肠的全胰头切除术治疗囊性肿瘤患者的经验，介绍了用于治疗腺瘤、交界性肿瘤和原位癌的全胰头切除术的手术技术。如果怀疑胰头周围十二指肠组织缺血，建议行胰头周围十二指肠节段切除术。通过 PubMed 检索文献，共收集了 305 例患者，其中约 40%的患者行十二指肠节段切除术，60%的患者行保留十二指肠和胆总管的全胰头切除术。
17 例患者的住院死亡率为 0%。在收集的 305 例患者中，住院死亡率为 0.65%，13.2%的患者发生胃排空延迟，18.2%的患者发生胰瘘。疾病复发率为 1.5%。175 例患者中有 32 例为原位癌。
对于良性囊性肿瘤，保留十二指肠的全胰头切除术是一种安全的手术方法，术后发病率和死亡率低。
