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目的总结中段胰腺切除治疗胰颈体部肿瘤的临床经验。方法对胰颈体部良性或低度恶性肿瘤13例患者行中段胰腺切除术治疗。术中游离胰颈体部切除肿瘤,行Roux-en-Y胰肠吻合或胰胃吻合。单吻合法5例,“Ω”形双吻合法6例,胰胃吻合法2例,胰肠吻合均放置肠造口管充分减压引流。结果切除胰腺平均直径4.3 cm,手术时间(237±43)分钟,出血量(287±75)ml。术后胰瘘2例,出血2例。浆液性囊腺瘤2例,黏液性囊腺瘤1例,实性假乳头状瘤3例,导管内乳头状黏液瘤2例,神经内分泌瘤1例,神经鞘瘤1例,功能性胰岛细胞瘤2例,无功能性胰岛细胞瘤1例。均痊愈出院,平均住院时间(18±5)天,随访9个月~3年未见低血糖和肿瘤复发及新发糖尿病。结论个体化中段胰腺切除术适合胰颈体部良性或低度恶性肿瘤治疗,保护了胰腺内外分泌功能,是一种安全、疗效确切的手术方式。
Objective To summarize the clinical experience of pancreatic neoplasms in the middle-stage pancreatectomy. Methods Thirteen patients with benign or low-grade malignant tumors of the neck of the pancreas were treated by pancreatectomy. Intraoperative free pancreatic body excision of the tumor, Roux-en-Y pancreaticojejunostomy or pancreatic anastomosis. 5 cases were single leg anastomosis, 6 cases were double leg anastomosis with “Ω” shape, 2 cases were treated with pancreatic anastomosis, pancreatic enterostoma was placed with full decompression and drainage. Results The average diameter of the resected pancreas was 4.3 cm, the operation time was 237 ± 43 minutes and the amount of bleeding was (287 ± 75) ml. Postoperative pancreatic fistula in 2 cases, 2 cases of bleeding. 2 cases of serous cystadenoma, 1 case of mucinous cystadenoma, 3 cases of solid pseudopapillary tumor, 2 cases of intraductal papillary myxoma, 1 case of neuroendocrine tumor, 1 case of schwannoma, 1 case of functional islet cells 2 cases of tumor, 1 case of non-functional islet cell tumor. All were cured and discharged. The average length of hospital stay was (18 ± 5) days. Hypoglycemia, tumor recurrence and new-onset diabetes were not observed during the follow-up of 9 months to 3 years. Conclusion Individualized middle-stage pancreatectomy is suitable for the treatment of benign or low-grade malignant tumors of the body of the pancreas and protects the exocrine and exocrine functions of the pancreas. It is a safe and effective surgical method.