胰腺和十二指肠肿瘤的手术策略
Surgical Strategies for Tumors of the Pancreas and Duodenum.
作者信息
Reveron-Thornton Rosyli F, Huang Kelly X, Delitto Daniel, Longaker Michael T, Norton Jeffrey A
机构信息
Department of Surgery, School of Medicine, Stanford University, Stanford, CA 94305, USA.
Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, School of Medicine, Stanford University, Stanford, CA 94305, USA.
出版信息
Cancers (Basel). 2025 Sep 22;17(18):3091. doi: 10.3390/cancers17183091.
The recommended surgery for pancreatic tumors is dependent on the diagnosis. For pancreatic adenocarcinoma, duodenal, and ampullary adenocarcinoma, a Whipple pancreaticoduodenectomy with lymph node dissection is recommended. For small < 2 cm or non-imageable gastrinomas, duodenal transillumination, duodenotomy, duodenal tumor excision and adjacent lymphadenectomy is recommended. For large > 3 cm gastrinomas, a Whipple pancreaticoduodenectomy with adjacent lymph node dissection is recommended. For small 1-2 cm insulinomas, intraoperative ultrasound with enucleation is recommended. If the patient with gastrinoma, insulinoma, or multiple nonfunctional NETs occurs in the setting of MEN-1, a subtotal pancreatectomy with or without splenectomy with enucleation of pancreatic head tumors is recommended, with adjacent lymph node dissection. The detail of each procedure is described with illustrations.
胰腺肿瘤的推荐手术方式取决于诊断结果。对于胰腺腺癌、十二指肠腺癌和壶腹腺癌，推荐行胰十二指肠切除术并进行淋巴结清扫。对于直径小于2cm或无法成像的胃泌素瘤，推荐行十二指肠透照、十二指肠切开术、十二指肠肿瘤切除术及邻近淋巴结切除术。对于直径大于3cm的胃泌素瘤，推荐行胰十二指肠切除术并进行邻近淋巴结清扫。对于直径1 - 2cm的小胰岛素瘤，推荐术中超声引导下摘除术。如果胃泌素瘤、胰岛素瘤或多发无功能神经内分泌肿瘤患者合并1型多发性内分泌腺瘤（MEN - 1），推荐行胰腺次全切除术，可选择或不进行脾切除术，并摘除胰头部肿瘤，同时进行邻近淋巴结清扫。每种手术的细节都配有插图说明。
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