Yasuda H, Takada T, Amano H, Yoshida M
First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2009-15.
BACKGROUND/AIMS: There is a diversity of mucin-producing tumors of the pancreas, including benign adenoma, malignant intraductal papillary carcinoma and invasive papillary carcinoma. However, there has been little discussion of appropriate techniques for surgically treating these tumors.
From August 1981 to December 1997, surgery was performed on 24 patients with mucin-producing pancreatic tumors (18 cases were malignant and 6 were benign). The surgical techniques which were used, the results of surgery, and the post-operative course of the patients are discussed.
Surgical resection was possible in 23 patients and included: 4 cases of total pancreatectomy; 1 case of pancreaticoduodenectomy (Whipple's procedure); 1 case of Whipple's procedure with a transverse colectomy; 13 cases of pylorus-preserving pancreaticoduodenectomy (PPPD); 2 cases of duodenum-preserving pancreatic head resection (DPPHR); 1 case of resection of the posterior segment of the pancreas (posterior segmentectomy); and, 1 case of resection of the medial segment of the pancreas (medial segmentectomy). Surgical resection was also used for 17 (94.4%) of the 18 patients with malignant tumor. There were no fatalities during or immediately following surgery. One patient developed transient duodenal stenosis after DPPHR. The 5-year survival rate after surgical resection was 68.4% for the 17 patients with malignant tumor. Mucus leaked from the pancreatic duct into the operating field of 1 patient during pancreatectomy. This patient died 7 months after surgery from a tumor metastasis of the thoracic mediastinal lymph nodes and peritoneal seeding. This episode illustrates the high risk associated with leakage of pancreatic duct mucus into the operating field. The longest surviving patient, 13 years and 11 months after total pancreatectomy, has good health and shows no signs of recurrence.
The prognosis for surgically resectable mucin-producing pancreatic tumors is better than that for invasive pancreatic duct carcinoma. When treating mucin-producing pancreatic tumors surgically, techniques which allow preservation of pancreatic and gastroenteric functions should be selected when possible. These techniques include PPPD, DPPHR and pancreatic segmentectomy. A total pancreatectomy should only be selected in cases where cancer has invaded the entire pancreas (especially when cancer has invaded the duct within the pancreatic head, through the tail). It may also be used when residual cancer cells have been detected by intra-operative pathological examination at the distal stump of the pancreas. During surgery with any technique, leakage of pancreatic duct mucus into the operating field must be avoided.
背景/目的：胰腺黏液生成性肿瘤具有多样性，包括良性腺瘤、恶性导管内乳头状癌和浸润性乳头状癌。然而，对于这些肿瘤的手术治疗适宜技术鲜少有人讨论。
1981年8月至1997年12月，对24例胰腺黏液生成性肿瘤患者实施了手术（18例为恶性，6例为良性）。讨论了所采用的手术技术、手术结果以及患者的术后病程。
23例患者可行手术切除，包括：4例全胰切除术；1例胰十二指肠切除术（惠普尔手术）；1例惠普尔手术联合横结肠切除术；13例保留幽门的胰十二指肠切除术（PPPD）；2例保留十二指肠的胰头切除术（DPPHR）；1例胰腺后段切除术（后段切除术）；以及1例胰腺中段切除术（中段切除术）。18例恶性肿瘤患者中的17例（94.4%）也接受了手术切除。手术期间及术后即刻均无死亡病例。1例患者在DPPHR术后出现短暂性十二指肠狭窄。17例恶性肿瘤患者手术切除后的5年生存率为68.4%。1例患者在胰切除术期间胰管黏液漏入手术野。该患者术后7个月死于胸段纵隔淋巴结肿瘤转移和腹膜种植。这一事件表明胰管黏液漏入手术野相关的高风险。存活时间最长的患者在全胰切除术后13年11个月，身体健康，无复发迹象。
可手术切除的胰腺黏液生成性肿瘤的预后优于浸润性胰腺导管癌。手术治疗胰腺黏液生成性肿瘤时，应尽可能选择能够保留胰腺和胃肠功能的技术。这些技术包括PPPD、DPPHR和胰腺节段切除术。仅在癌症侵犯整个胰腺（尤其是癌症侵犯胰头内导管并延伸至胰尾）的情况下，或术中病理检查在胰腺远端残端检测到残留癌细胞时，才应选择全胰切除术。在采用任何技术进行手术时，必须避免胰管黏液漏入手术野。
