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目的:评价胰腺局部精准切除术(尽可能保留有功能的胰腺组织)的临床可行性、安全性和疗效。方法:分析2007年1月以来本科开展的17例次胰腺局部精准切除术的临床资料。结果:保脾胰体尾切除术11例,中段胰腺切除术5例,保留十二指肠的胰头切除术1例,术后均康复出院。平均手术时间(3.0±0.78)h,术中平均出血量(258.8±86.65)ml,全组病例术中均未输血。保脾组中2例快速病理示恶性肿瘤后即刻加行脾切除术,1例术后胰尾小囊肿;中段胰组中1例术后脾静脉迟发性破裂出血再手术切除脾脏;保留十二指肠胰头切除病例术后短期小流量胰瘘。全组术后血小板计数为(273.1±43.76)×109L-1,术后平均住院时间为(15.8±7.07)d,术后随访4～48个月,病理提示良性肿瘤者均未见复发及转移。结论:胰腺局部精确切除术治疗胰腺良性肿瘤疗效确切,并可达到最小创伤、最大脏器保有和最佳康复的效果。
Objective: To evaluate the clinical feasibility, safety and efficacy of local pancreatectomy (preserving functional pancreas as much as possible). Methods: The clinical data of 17 cases of sub-pancreatic local excision performed since January 2007 were analyzed. Results: 11 cases of splenomegaly and tail-conserving spleen and pancreatectomy, 5 cases of middle pancreatectomy and 1 case of pancreatic head resection with duodenal resection were recovered and discharged after operation. The average operation time (3.0 ± 0.78) h, mean intraoperative blood loss (258.8 ± 86.65) ml, no blood transfusion in all cases. Spleen resection was performed in 2 cases of rapidly pathological malignant tumors in the spleen-retaining group and in 1 case of post-operative pancreatic tail cyst. One case of postoperative splenic vein delayed rupture of hemorrhage and then resection of the spleen; ten Short-term small-flow pancreatic fistula after resection of the pancreas of the duodenum. The total postoperative platelet count was (273.1 ± 43.76) × 109L-1 and the average postoperative hospital stay was (15.8 ± 7.07) days. The patients were followed up for 4 to 48 months. The pathological findings showed no recurrence and metastasis . CONCLUSIONS: Pancreas local excision for the treatment of benign pancreatic tumors is effective and achieves the minimal trauma, maximal organ preservation and optimal rehabilitation.