Duodenum-Preserving Pancreatic Head Resection: Preliminary Report on Indications and Techniques

十二指腸保留式胰臟頭部切除術：適應症及手術方式初報

洪進昇(Chin-Sheng Hung) ； 林本仁(Peter Lin) ； 田郁文(Yu-Wen Tien) ； 李伯皇(Po-Huang Lee)

《Formosan Journal of Surgery》 37卷6期 (2004/12) Pp. 254-260

https://doi.org/10.29833/FJS.200412.0002

摘要

以往認為由於共通的血流供應，要切除胰臟頭部就必須切除十二指腸。但隨著對該區域解剖位置的更深入了解，陸續開始有一些報告宣稱可以在保留十二指腸的情況下成功地切除胰臟頭部。不過關於十二指腸保留式胰臟頭部切除術的手術適應症卻仍然有許多爭論。本文將藉由本院六個成功實施十二指腸保留式胰臟頭部切除術的病例來探討此手術方式最適宜的適應症及方法。
在這六位病患中有四位是罹患慢性胰臟炎併發劇烈腹痛的病例，另外二位是罹患胰臟頭部囊狀腫瘤的病例。主要的手術方式為：在不鬆動十二指腸的情況下，於上腸擊膜靜脈上方切斷胰臟頸部，再沿著前上胰臟十二指腸動脈切斷胰臟頭部。術後，這六位病人都未出現與十二指腸缺血有關的併發症。四位慢性胰臟炎病患，術後都不再需要止痛藥；另二位胰臟頭部囊狀腫瘤的病患，在術後追蹤32及30個月後都未發現腫瘤再發。
我們的結論是，「不鬆動十二指腸的情況下，於上腸擊膜靜脈上方切斷胰臟頸部，再沿著前上胰臟十二指腸動脈切斷胰臟頭部」的十二指腸保留式胰臟頭部切除手術，能有效地保留十二指腸的血流供應。這種術式最適合於胰臟頭部有炎性腫塊；但十二指腸及總膽管未見阻塞的慢性胰臟炎病患，而良性或低惡性的胰臟頭部腫瘤，只有在冰凍切片證實有足夠切除範圍時，才適合接受十二指腸保留式胰臟頭部切除術。

並列摘要

Objectives To define the optimal indications for and operative method of duodenum-preserving pancreatic head resection.
Methods: The clinicopathologic data, surgical procedures, complications, and clinical outcomes of all patients treated with duodenum-preserving pancreatic head resections at our hospital were reviewed.
Results: Six patients (four with chronic pancreatitis and two with cystic pancreatic head tumor) were treated with duodenum-preserving pancreatic head resection (DPPHR). No patient suffered any complication attributable to duodenal ischemia. No tumor recurrence was noted in the two patients with pancreatic head tumor during the follow-up period of 32 and 30 months, respectively. Dramatic pain relief was noted in all of the four patients with chronic pancreatitis during a median follow-up period of 18 months (range: 6 to 27 months).
Conclusions: with methods of cutting the pancreas along the line of the anterior superior pancreatico-duodenal artery (ASPD) without doing Kocher's maneuver, duodenum-preserving pancreatic head resection can be safely performed. Duodenum-preserving pancreatic head resection is best indicated for chronic pancreatitis patients with an inflammatory head mass but without obstruction of the common bile duct or duodenum. For patients with pancreatic head cystic tumor, we try to apply this method of operation instead of the Whipple operation, and the results have been satisfactory. However, we should emphasize that duodenum-preserving pancreatic head resection should not be done until frozen section proves benignancy and free section margins.

並列關鍵字

chronic pancreatitis ； duodenum-preserving pancreatic head resection ； Whipple procedure