Beger Hans G
c/o Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Chirurgie (Heidelb). 2024 Jun;95(6):461-465. doi: 10.1007/s00104-024-02070-5. Epub 2024 Apr 3.
Currently, the most frequently used surgical treatment for symptomatic, benign, premalignant cystic and neuroendocrine neoplasms of the pancreatic head is the Whipple procedure or pylorus-preserving pancreatoduodenectomy (PD). However, when performed for treatment of benign tumors, PD is a multiorgan resection involving loss of pancreatic and extrapancreatic tissue and functions. PD for benign neoplasm is associated with the risk of considerable early postoperative complications and an in-hospital mortality of up to 5%. Following the Whipple procedure a new onset of diabetes mellitus is observed in 14-20% and new exocrine insufficiency in 25-45%, leading to metabolic dysfunction and impairment of quality of life persisting after resection of benign tumors. Symptomatic neoplasms are indication for surgery. Patients with asymptomatic pancreatic tumors are treated according to the criteria of surveillance protocols. The goal of surgical treatment for asymptomatic patients is, according to the guideline criteria, interruption of the surveillance program before the development of an advanced stage cancer associated with the neoplasm. Tumor enucleation and duodenum-preserving pancreatic head resection, either total or partial, are parenchyma-sparing resections for benign neoplasms of the pancreatic head. The first choice for small tumors is enucleation; however, enucleation is associated with an increased risk of pancreatic fistula B + C following pancreatic main duct injury. Duodenum-preserving total or partial pancreatic head resection has the advantage of low postoperative surgery-related complications, a mortality of < 0.5% and maintenance of the endocrine and exocrine pancreatic functions. Parenchyma-sparing pancreatic head resections should replace classical Whipple procedures for neoplasms of the pancreatic head.
目前，对于胰头部有症状的良性、癌前囊性及神经内分泌肿瘤，最常用的手术治疗方法是惠普尔手术或保留幽门的胰十二指肠切除术（PD）。然而，在用于治疗良性肿瘤时，PD是一种多器官切除术，会导致胰腺及胰腺外组织和功能丧失。良性肿瘤的PD手术与术后早期出现严重并发症的风险相关，住院死亡率高达5%。惠普尔手术后，14% - 20%的患者会新发糖尿病，25% - 45%的患者会出现新的外分泌功能不全，导致代谢功能障碍，且良性肿瘤切除后生活质量受损仍会持续。有症状的肿瘤是手术指征。无症状胰腺肿瘤患者根据监测方案标准进行治疗。根据指南标准，无症状患者手术治疗的目标是在与肿瘤相关的晚期癌症发生之前中断监测程序。肿瘤剜除术和保留十二指肠的胰头切除术（全切除或部分切除）是针对胰头部良性肿瘤的实质保留性切除术。小肿瘤的首选治疗方法是剜除术；然而，剜除术与胰管主干损伤后发生B + C级胰瘘的风险增加相关。保留十二指肠的胰头全切除或部分切除术具有术后手术相关并发症低、死亡率<0.5%以及维持胰腺内分泌和外分泌功能的优点。对于胰头部肿瘤，实质保留性胰头切除术应取代经典的惠普尔手术。
