保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤：单中心66例报告
| 作者: |
1肖卫东,
2林生荣,
1吴安涛,
1蔡军,
1郑东辉,
1余永欢,
1李勇
1 南昌大学第一附属医院 普通外科，江西 南昌330006 2 江苏省东台市人民医院 普通外科，江苏 东台 224200 |
| 通讯: |
肖卫东
Email: frankxwd@126.com |
| DOI: | 10.3978/.2018.03.003 |
| 基金: | 国家自然科学基金资助项目（81660401）；江西省卫生计生委科技计划基金资助项目（20155171）。 |
摘要
目的：探讨保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤的临床价值。
方法：回顾性分析南昌大学第一附属医院普通外科2009年1月—2016年12月间66例胰腺良性或低度恶性肿瘤施行保留器官的胰腺切除术患者的临床资料。其中胰岛素瘤34例，实性假乳头状瘤16例，浆液性囊腺瘤9例，导管内乳头状黏液瘤4例，无功能性神经内分泌肿瘤、副神经节瘤和黏液性囊腺瘤各1例；肿瘤局部切除术34例，中段胰腺切除术10例，保留脾脏的胰体尾切除术13例，保留幽门的胰十二指肠切除术6例，保留十二指肠的胰头切除术3例。
结果：平均手术时间为（163.6±77.4）min，平均术中出血量为（234.4±242.7）mL，平均术后住院时间为（11.3±8.1）d。总体腹部并发症、残胰生化漏、Ｂ/C级胰瘘、腹腔内感染、胃排空延迟和腹腔内出血发生率分别为36.4%、15.2%、10.6%、6.1%、3.0%和1.5%。无再手术和手术相关死亡。术后平均随访（47.2±25.6）个月，新发糖尿病和需胰酶替代治疗发生率分别为3.1%（排除34例胰岛素瘤患者）和1.5%，无肿瘤复发和转移。
结论：保留器官的胰腺切除术能最大程度保留胰腺实质和周围脏器，避免胰腺的内外分泌或脾脏功能的过度丧失，可作为胰腺良性或低度恶性肿瘤的首选术式。
关键词：
胰腺良性/低度恶性肿瘤；保留器官；胰腺切除手术；临床疗效
方法：回顾性分析南昌大学第一附属医院普通外科2009年1月—2016年12月间66例胰腺良性或低度恶性肿瘤施行保留器官的胰腺切除术患者的临床资料。其中胰岛素瘤34例，实性假乳头状瘤16例，浆液性囊腺瘤9例，导管内乳头状黏液瘤4例，无功能性神经内分泌肿瘤、副神经节瘤和黏液性囊腺瘤各1例；肿瘤局部切除术34例，中段胰腺切除术10例，保留脾脏的胰体尾切除术13例，保留幽门的胰十二指肠切除术6例，保留十二指肠的胰头切除术3例。
结果：平均手术时间为（163.6±77.4）min，平均术中出血量为（234.4±242.7）mL，平均术后住院时间为（11.3±8.1）d。总体腹部并发症、残胰生化漏、Ｂ/C级胰瘘、腹腔内感染、胃排空延迟和腹腔内出血发生率分别为36.4%、15.2%、10.6%、6.1%、3.0%和1.5%。无再手术和手术相关死亡。术后平均随访（47.2±25.6）个月，新发糖尿病和需胰酶替代治疗发生率分别为3.1%（排除34例胰岛素瘤患者）和1.5%，无肿瘤复发和转移。
结论：保留器官的胰腺切除术能最大程度保留胰腺实质和周围脏器，避免胰腺的内外分泌或脾脏功能的过度丧失，可作为胰腺良性或低度恶性肿瘤的首选术式。
Organ preserving pancreatectomy for pancreatic benign or low-grade malignant tumor: a report of 66 cases in a single institution
CorrespondingAuthor:XIAO Weidong Email: frankxwd@126.com
Abstract
Objective: To investigate the clinical value of organ preserving pancreatectomy in treatment of benign or low-grade malignant pancreatic tumors.
Methods: The clinical data of 66 patients with pancreatic benign or low-grade malignant tumor who underwent organ preserving pancreatectomy from January 2009 to December 2016 in the Department of General Surgery of the First Affiliated Hospital, Nanchang University were retrospectively analyzed. Of the patients, the lesion included insulinoma in 34 cases, solid pseudopapillary tumor in 6 cases, serous cystadenoma in 9 cases, intraductal papillary mucinous tumor in 4 cases, and nonfunctional neuroendocrine tumor, paraganglioma and mucinous cystadenoma in one case each; 34 cases underwent tumor enucleation, 10 cases underwent middle segmental pancreatectomy, 13 cases underwent spleen-preserving distal pancreatectomy, 6 cases underwent pylorus-preserving pancreaticoduodenectomy and 3 cases underwent duodenum-preserving pancreatic head resection.
Results: The mean operative time was (163.6±77.4) min, intraoperative blood loss was (234.4±242.7) mL, and length of postoperative hospital stay was (11.3±8.1) d. The incidence of overall abdominal complications, biochemical pancreatic leak, grade B/C pancreatic fistula, intra-abdominal infection, delayed gastric emptying and intra-abdominal bleeding were 36.4%, 15.2%, 10.6%, 6.1%, 3.0% and 1.5%, respectively. No reoperation was required and no death occurred in any of the patients. After the mean follow-up period of (47.2±25.6) months, the incidence of new-onset diabetes mellitus and requirement of pancreatic enzyme replacement therapy was 3.1% (the34 cases with insulinoma were excluded) and 1.5% respectively, and no recurrence or metastasis was observed.
Conclusion: Organ preserving pancreatectomy can maximally preserve the pancreatic parenchyma and adjacent organs, avoid the excessive loss of pancreatic endocrine and exocrine functions and preserve the function of the spleen. It should be considered as the first option for treatment of benign or low-grade malignant pancreatic tumor.
Keywords：
Pancreatic benign/low-grade malignant tumor; Organ-preserving; Pancreatectomy; Clinical efficacy
Methods: The clinical data of 66 patients with pancreatic benign or low-grade malignant tumor who underwent organ preserving pancreatectomy from January 2009 to December 2016 in the Department of General Surgery of the First Affiliated Hospital, Nanchang University were retrospectively analyzed. Of the patients, the lesion included insulinoma in 34 cases, solid pseudopapillary tumor in 6 cases, serous cystadenoma in 9 cases, intraductal papillary mucinous tumor in 4 cases, and nonfunctional neuroendocrine tumor, paraganglioma and mucinous cystadenoma in one case each; 34 cases underwent tumor enucleation, 10 cases underwent middle segmental pancreatectomy, 13 cases underwent spleen-preserving distal pancreatectomy, 6 cases underwent pylorus-preserving pancreaticoduodenectomy and 3 cases underwent duodenum-preserving pancreatic head resection.
Results: The mean operative time was (163.6±77.4) min, intraoperative blood loss was (234.4±242.7) mL, and length of postoperative hospital stay was (11.3±8.1) d. The incidence of overall abdominal complications, biochemical pancreatic leak, grade B/C pancreatic fistula, intra-abdominal infection, delayed gastric emptying and intra-abdominal bleeding were 36.4%, 15.2%, 10.6%, 6.1%, 3.0% and 1.5%, respectively. No reoperation was required and no death occurred in any of the patients. After the mean follow-up period of (47.2±25.6) months, the incidence of new-onset diabetes mellitus and requirement of pancreatic enzyme replacement therapy was 3.1% (the34 cases with insulinoma were excluded) and 1.5% respectively, and no recurrence or metastasis was observed.
Conclusion: Organ preserving pancreatectomy can maximally preserve the pancreatic parenchyma and adjacent organs, avoid the excessive loss of pancreatic endocrine and exocrine functions and preserve the function of the spleen. It should be considered as the first option for treatment of benign or low-grade malignant pancreatic tumor.