Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
J Zhejiang Univ Sci B. 2017;18(10):906-916. doi: 10.1631/jzus.B1600597.
The aim of this study was to evaluate the safety and efficiency of enucleation (EU) for proximal pancreatic non-invasive neoplasms.
Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included. Different operations and outcomes were analyzed.
A total of 123 patients were enrolled. Forty patients (32.5%) underwent EU including 18 patients who had tumors close to the main pancreatic duct (MPD). Sixty-one patients (49.6%) had pancreaticoduodenectomy (PD) performed and 22 (17.9%) underwent central pancreatectomy (CP). Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors. Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group. PD was associated with the greatest complication rate (55.7%), followed by EU (50%) and CP (40.9%), though the pancreatic fistula rate after EU was the highest (50%), especially in patients with tumors larger than 3 cm and tumors close to the MPD. EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function.
EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.
本研究旨在评估剜除术（EU）治疗胰体近侧部非侵袭性肿瘤的安全性和有效性。
纳入 1998 年 1 月至 2014 年 4 月期间在浙江大学附属第二医院接受治疗的胰体近侧部单发非侵袭性肿瘤患者。分析不同手术方式及结局。
共纳入 123 例患者。40 例行 EU，其中 18 例肿瘤靠近主胰管（MPD）。61 例行胰十二指肠切除术（PD），22 例行胰体中部切除术（CP）。病理结果包括神经内分泌肿瘤、囊性病变和实性假乳头状肿瘤。EU 组的手术时间、术中出血量和住院时间均显著缩短。PD 的并发症发生率最高（55.7%），其次是 EU（50%）和 CP（40.9%），但 EU 后的胰瘘发生率最高（50%），尤其是肿瘤直径大于 3cm 和靠近 MPD 的患者。EU 在保留胰腺实质和内外分泌功能方面具有优势。
对于胰体近侧部肿瘤，EU 可安全、有效地进行，与标准切除术相比，即使肿瘤大于 3cm 且靠近 MPD，其结局也更佳。
