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胰头十二指肠切除术经过约50年的不断演变,目前基本仿造Whipple 或Child 术式。本术式之所以不断改进,主要是为了减少手术合并症和手术病死率,提高手术治愈率。其中尤以对术后发生胰瘘的预防,控制在最低限度。手术病死率已稳定在2～10%之间,基本上得到了解决。此外少数学者为了研究手术后的消化和胃肠道内分泌功能,也在试做各种不同的术式。至于Whipple 和Child两种术式从胰瘘的发生率来看,近年来,都有大幅度降低,二者几乎相等,只是术者的素日手术习惯不同而已。目前关于手术术式研究的趋向是对恶性肿瘤在胰头、十二指肠切除的基础上,进一步扩大切除问题,其中包括全胰切除、周围淋巴结廓清术,以及局部血管合并切除、重建等术式。对保留幽门的胰十二指肠吻合术式,多数主张应慎重掌握手术指征,适应良性和早期壶腹癌,以及远位转移和年老体弱的姑息性手术,其理由是担心较大的壶腹区癌运用此术式切除能否彻底。本刊将各术式介绍供同道们在实践中进一步积累经验。
After approximately 50 years of continuous evolution, pancreatoduodenectomy has basically replicated Whipple or Child procedures. The reason for the continuous improvement of this surgical method is mainly to reduce surgical complications and surgical mortality and improve the surgical cure rate. Among them, the prevention of postoperative pancreatic fistula is controlled to a minimum. The surgical mortality rate has stabilized between 2 and 10% and has basically been resolved. In addition, a few scholars are also trying different kinds of surgical procedures in order to study the digestive and gastrointestinal endocrine functions after surgery. As for the two surgical methods of Whipple and Child, the incidence of pancreatic fistula has been greatly reduced in recent years. The two are almost equal, except that the surgical habits of the surgeon are different. At present, the trend of surgery is to further expand the resection of malignant tumors on the basis of pancreatic head and duodenal resection, including total pancreatectomy, peripheral lymphadenectomy, and local vascular resection and reconstruction. formula. For pylorus-preserving pancreatoduodenostomy, most advocates should carefully master the surgical indications to adapt to benign and early ampullary carcinoma, as well as distant metastases and old and infirm palliative surgery. The ampulla area cancer can be completely removed using this surgical technique. The journal will introduce various surgical methods for fellow practitioners to further accumulate experience in practice.