Girish Suraj, Kapil Nagaraj, Kannan Naveen
General Surgery, Meenakshi Medical College and Research Institute, Kanchipuram, IND.
Surgical Gastroenterology, Meenakshi Medical College and Research Institute, Kanchipuram, IND.
Cureus. 2021 Oct 8;13(10):e18617. doi: 10.7759/cureus.18617. eCollection 2021 Oct.
Central pancreatectomy is a pancreatic parenchymal sparing surgery usually indicated for benign and borderline malignant tumors of the neck and proximal body of the pancreas. Due to the presence of extensive intra-pancreatic spread, pancreatic parenchyma sparing procedures such as central pancreatectomy are invariably deferred in pancreatic malignancy. The need for management of two pancreatic stumps with a usually soft texture and non-dilated ducts, given the indications, increases the risk of pancreatic fistula and therefore morbidity. Proximal stump management is usually a closure either by suture or stapler with reinforcements; the technique preferred depends on the experience of the surgeon and is mostly extrapolated from distal pancreatectomy. Distal stump management is the Achilles' heel owing to the texture of the pancreas and pancreatic duct size. Need for additional mobilization may have a bearing on the perfusion of the pancreatic stump and hence may lead to clinically relevant leaks. The use of octreotide accentuating the said vascular insufficiency may not be an overstatement. Here we present a case of solid pseudopapillary tumor (SPT) of the neck and proximal body of the pancreas in which a central pancreatectomy with falciform patch closure of the proximal stump and binding pancreaticogastrostomy (PG) was contemplated and further we discuss the types of reconstruction with special reference to the vascular pattern of distal pancreas.
胰体尾切除术是一种保留胰腺实质的手术，通常适用于胰腺颈部和胰体近端的良性及交界性恶性肿瘤。由于胰腺内广泛扩散的存在，对于胰腺恶性肿瘤，诸如胰体尾切除术等保留胰腺实质的手术总是被推迟。鉴于手术指征，需要处理两个质地通常较软且导管未扩张的胰腺残端，这增加了胰瘘的风险，进而增加了发病率。近端残端的处理通常是用缝线或吻合器进行缝合，并辅以加固；所选用的技术取决于外科医生的经验，且大多是从胰头十二指肠切除术推断而来。由于胰腺的质地和胰管大小，远端残端的处理是关键难题。额外游离的需求可能会影响胰腺残端的血供，从而可能导致具有临床意义的渗漏。使用奥曲肽加剧上述血管不足或许并非言过其实。在此，我们呈现一例胰腺颈部和胰体近端的实性假乳头状瘤（SPT）病例，该病例考虑进行胰体尾切除术，近端残端采用镰状补片缝合，并行捆绑式胰胃吻合术（PG），此外，我们还特别参照胰腺远端的血管模式讨论了重建类型。
