摘要
随着器官保留理念被外科医师广泛接受,保留十二指肠的胰头切除术(DPPHR)逐渐被用于治疗胰头部肿块型慢性胰腺炎及良性或低度恶性肿瘤。DPPHR手术区域解剖及血供复杂,术后易发生并发症。笔者在经典DPPHR术式上进行改良,提出保留十二指肠胰头全切除术(DPtPHR)。本文就上述要难点对DPtPHR手术方式的演变、手术操作的要点及手术适应证的选择进行简介。DPtPHR的操作要点在于完整切除胰头及病变组织、保障十二肠血供与防止胆道损伤与缺血,其适应证主要包括胰头肿块型慢性胰腺炎、浆液/黏液囊腺瘤、G1/G2级神经内分泌肿瘤、实性假乳头状瘤与分支型导管内乳头状瘤。值得注意的是,需要结合术前影像检查、术中探查与冰冻快速切片明确诊断并排除癌变。
With the idea of organ preserving in surgery, duodenum-preserving pancreatic head resection （DPPHR） has been increasingly performed in the treatment of mass-type chronic pancreatitis or benign/low-grade malignant tumor in the pancreatic head. Because of the complex anatomy and blood-supply in the surgical area, DPPHR is associated with a high incidence of complications. We modified DPPHR as a duodenum preserving total pancreatic head resection （DPtPHR）. This article introduced the development of DPtPHR and its key operative procedures and indications. The difficulty includes total resection of the pancreatic head with preservation of the blood supply to the duodenum and bile duct. DPtPHR could be performed in patients with chronic pancreatitis complicated by a mass in the head, cystadenoma, neuroendocrine tumor of G1/G2 grade, solid papilloma, and branch intra-pancreatic ductal papilloma. It is worth noting that precise diagnosis should be performed with preoperative inmging, intraoperative exploration, and pathological examination of frozen sections.
出处
《中华普外科手术学杂志（电子版）》
2013年第3期15-17,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
国家"十一五"科技支撑计划(2006BAI02A13)
国家自然科学基金(30571817)
国家自然科学基金(30972903)
关键词
胰腺肿瘤
胰腺炎
慢性
胰十二指肠切除术
Pancreatic neoplasms
Pancreatitis, chronic
Pancreaticodenectomy
