Ahrén B, Tranberg K G, Andrén-Sandberg A, Bengmark S
Department of Surgery, Lund University, Sweden.
HPB Surg. 1990 Mar;2(1):29-35; discussion 35-9. doi: 10.1155/1990/73475.
This paper presents a 2-year series of 26 consecutive pancreatectomies for periampullary cancer where the pancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico-digestive anastomosis. The follow-up period was 14 months or more. Seven patients developed operative complications. Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after 2-4 months. Intraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of these patients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of 3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital median stay was 27 days (range 10-83 days). Eighteen patients have died after 4-30 months in recurrent disease and seven patients are alive after a follow-up period of 15-29 months. Pancreatic endocrine function seemed well preserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotal pancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality. Although the conclusion should be tempered by the small number of patients, the results justify continued evaluation of this technique with long-term follow-up.
本文介绍了连续2年对26例壶腹周围癌患者进行胰切除术的系列病例，其中胰尾用吻合器闭合，以避免与胰-消化道吻合相关的并发症。随访期为14个月或更长时间。7例患者出现手术并发症。3例患者发生胰瘘。其中2例患者的胰瘘在2至4个月后自行闭合。4例患者发生腹腔内脓肿，需要手术引流。在这些患者中，有1例脓肿侵蚀了大血管，导致死亡，手术死亡率为3.8%。7例患者出现短暂的术后胃潴留。术后住院中位时间为27天（范围10 - 83天）。18例患者在复发疾病后4至30个月死亡，7例患者在随访15至29个月后仍存活。胰腺内分泌功能似乎保存良好；仅1例患者发生糖尿病。总之，用吻合器闭合胰腺残端的次全胰切除术似乎具有较低的发病率和死亡率。尽管由于患者数量较少，结论应有所保留，但这些结果证明值得对该技术进行长期随访的持续评估。
