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胰十二指肠切除术的技术要点及其结果。

Technical aspects of pancreaticoduodenectomy and their outcomes.

作者信息

Giuliano Katherine, Ejaz Aslam, He Jin

机构信息

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

Chin Clin Oncol. 2017 Dec;6(6):64. doi: 10.21037/cco.2017.09.01. Epub 2017 Sep 26.

Abstract

Pancreatic cancer is the fourth leading cause of cancer-related death in the Unites States and is rising in incidence. For the 15-25% of patients who do not have either metastatic or locally advanced disease, surgical resection with pancreaticoduodenectomy is the standard of care and results in improved 5-year survival of 15-25%. While mortality at high-volume centers is less than 5%, morbidity remains high at approximately 30-45%. This paper reviews technical aspects of pancreaticoduodenectomy and their outcomes. Specifically, we review technique and the outcome literature on vascular reconstruction, attempts to decrease delayed gastric emptying (DGE), including pylorus-preserving versus classic pancreaticoduodenectomy and gastrojejunostomy (GJ) technique, as well as attempts to decrease the rate of pancreatic fistula, including the use of pancreatic stents, fibrin sealant, and pancreaticojejunostomy (PJ) technique. Vascular resection and reconstruction have been associated with increased morbidity and mortality. However, the literature suggests that if it allows for an R0 resection, the survival is improved with comparable complication rates. DGE, one of the most common post-pancreaticoduodenectomy complications, has not been reliably decreased with various technical modifications of the GJ. The incidence of pancreatic fistula, one of the most morbid postoperative complications, is not definitively reduced by either the use of pancreatic stents or fibrin sealant. Additional research is needed to determine methods to further decrease rates of morbidity.

摘要

胰腺癌是美国癌症相关死亡的第四大主要原因,且发病率正在上升。对于15%至25%既没有转移性疾病也没有局部晚期疾病的患者,胰十二指肠切除术是标准的治疗方法,可使5年生存率提高15%至25%。虽然大型中心的死亡率低于5%,但发病率仍然很高,约为30%至45%。本文回顾了胰十二指肠切除术的技术方面及其结果。具体而言,我们回顾了血管重建的技术和结果文献,尝试降低延迟胃排空(DGE),包括保留幽门与经典胰十二指肠切除术以及胃空肠吻合术(GJ)技术,以及尝试降低胰瘘发生率,包括使用胰管支架、纤维蛋白密封剂和胰肠吻合术(PJ)技术。血管切除和重建与发病率和死亡率增加有关。然而,文献表明,如果能实现R0切除,生存率会提高,且并发症发生率相当。DGE是胰十二指肠切除术后最常见的并发症之一,通过GJ的各种技术改进未能可靠地降低其发生率。胰瘘是术后最严重的并发症之一,使用胰管支架或纤维蛋白密封剂均未明确降低其发生率。需要进一步研究以确定进一步降低发病率的方法。

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