Nimura Y
First Department of Surgery, Nagoya University School of Medicine, Japan.
Pancreas. 1998 Apr;16(3):227-32.
In the 1980s, Japanese pancreatic surgeons used aggressive strategies to treat pancreatic cancer under the influence of Fortner's regional pancreatectomy and developed several surgical approaches including extended lymph node and connective tissue clearance with autonomic nerve dissection around the celiac and superior mesenteric arteries. Nagakawa's "translateral retroperitoneal approach" in extended radical pancreatectomy was accepted and used by many Japanese surgeons; however, whereas this operation prolonged postoperative survival, it also induced high rates of postoperative complications and ultimately failed to improve the quality of the patient's life. A pylorus-preserving pancreatoduodenectomy with modified extended dissection of the lymph node and connective tissues did not decrease the survival rate for resected patients but improved their quality of life. In the next decade, Takada developed duodenum-preserving total pancreatic head resection, which preserves the integrity of the digestive and biliary tracts. This operation, to anastomose the main pancreatic duct with the duodenum, is unique and is applicable to benign or low-grade malignant lesions of the pancreas. Adjuvant treatments have not offered satisfactory results as expected. Finally, it is recommended that the aggressive Japanese surgical strategies be reevaluated in a formal trial with a prospective randomized study to improve the quality and longevity of the patients' lives.
20世纪80年代，在福特纳区域胰腺切除术的影响下，日本胰腺外科医生采用积极的策略治疗胰腺癌，并开发了几种手术方法，包括扩大淋巴结清扫范围以及在腹腔干和肠系膜上动脉周围进行自主神经解剖的结缔组织清扫。长川在扩大根治性胰腺切除术中采用的“经外侧腹膜后入路”被许多日本外科医生接受并使用；然而，虽然这种手术延长了术后生存期，但也导致了较高的术后并发症发生率，最终未能改善患者的生活质量。保留幽门的胰十二指肠切除术联合改良扩大淋巴结及结缔组织清扫术，虽未降低切除患者的生存率，但改善了他们的生活质量。在接下来的十年里，高田开发了保留十二指肠的全胰头切除术，该手术保留了消化道和胆道的完整性。这种将主胰管与十二指肠吻合的手术独具特色，适用于胰腺良性或低级别恶性病变。辅助治疗并未取得预期的满意效果。最后，建议通过前瞻性随机研究的正式试验重新评估日本积极的手术策略，以提高患者的生活质量和寿命。
