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目的对全胰切除术的疗效进行评价。方法对2003年4月至2006年6月21例接受全胰切除术的患者的临床资料进行回顾性分析。结果 21例行全胰切除术的患者中1例联合横结肠切除,1例联合全胃切除,9例行门静脉-肠系膜上静脉部分切除端端吻合术,9例行门静脉-肠系膜上静脉部分切除人造血管间置术,其中联合腹腔干切除8例,联合腹腔干、肝固有动脉切除4例,联合腹腔干、肝总动脉切除和肠系膜上动脉部分切除端端重建1例。12例(57.1%)发生术后并发症;5例(23.8%)术后30 d 内死亡。术后每日胰岛素用量18~28 U,均能较好地控制血糖。生活质量较术前有明显提高。16例获得随访,中位生存期为9.2个月(1.2~13.0个月),其中胰腺导管癌中位生存期为7个月(1.2~9.0个月),侵袭性导管内乳头状黏液性肿瘤中位生存期为11.3个月(10.0~13.0个月)。结论全胰切除术不提高生存期,而并发症和手术死亡率增加,但可改善生活质量,可作为胰管内乳头状黏液性肿瘤的手术选择,对胰腺导管腺癌则必须考虑手术的必要性。全胰切除术后糖尿病是可控的。
Objective To evaluate the efficacy of total pancreatectomy. Methods The clinical data of 21 patients undergoing total pancreatectomy from April 2003 to June 2006 were analyzed retrospectively. Results Of the 21 patients undergoing total pancreatectomy, one patient underwent transcortical ablation, one patient underwent combined total gastrectomy, and 9 patients underwent partial anastomosis with portal vein-superior mesenteric vein. Nine patients underwent partial portal vein-superior mesenteric vein resection Among them, 8 cases were combined with celiac resection, 4 cases combined with celiac and hepatic artery resection, and 1 case was treated with celiac, common hepatic artery resection and partial superior mesenteric artery resection. Postoperative complications occurred in 12 (57.1%) patients and in 5 (23.8%) patients within 30 days after operation. Postoperative daily insulin dosage 18 ~ 28 U, are better able to control blood sugar. The quality of life was significantly improved compared with preoperative. Sixteen patients were followed up for a median survival of 9.2 months (range, 1.2 to 13.0 months). The median survival of pancreatic ductal carcinoma was 7 months (range 1.2-9.0 months), invasive ductal papillary mucinous neoplasm The median survival was 11.3 months (10.0 to 13.0 months). Conclusion Total pancreatectomy does not improve survival, but complications and operative mortality increase, but can improve the quality of life, can be used as pancreatic ductal papillary mucinous tumor surgical options, pancreatic ductal adenocarcinoma must consider the necessity of surgery . Total pancreatectomy diabetes is controllable.