Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery.
Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery.
复制标题
胰头切除联合十二指肠节段切除术并保留胃十二指肠动脉。
作者：
A. Nakao
背景/目标
对良性胰头疾病行保留十二指肠的胰头切除术。完全切除胰头，保留胆总管和十二指肠，有时会因缺血引起胆总管或十二指肠坏死。我们提出了一种简单、易行、安全的胰头全切除加十二指肠节段性切除的方法，以预防保留胰头的十二指肠切除可能引起的并发症。
方法论
胰头切除加十二指肠节段性切除，包括小乳头和大乳头。通过保留胃右动脉，保留了5-7厘米的十二指肠第一部分，具有良好的动脉循环。此外，通过保留胰十二指肠前下动脉，保留了十二指肠第二部分的第三部分和肛侧，具有良好的动脉循环。胰头切除加3-4厘米的十二指肠节段性切除，包括小乳头和大乳头，完成了这个过程。然后用胰胃吻合术、十二指肠端端吻合术和胆总管十二指肠端侧吻合术重建消化道。
结果
14例胰头疾病，主要为良性肿瘤，均获成功，无严重并发症。术后生活质量令人满意。
结论
该术式可安全、有效地完成胰头区良性肿瘤的全切除手术。
BACKGROUND/AIMS
Duodenum-preserving pancreatic head resection has been performed for benign pancreatic head diseases. Complete resection of the pancreatic head with preservation of common bile duct and the duodenum sometimes causes common bile duct or duodenal necrosis due to ischemia. We propose the simple, easy and safe procedure for complete resection of pancreatic head with segmental duodenectomy to prevent complications, which may be caused on duodenum preserving pancreatic head resection.
METHODOLOGY
Pancreatic head resection with segmental duodenectomy including minor and major papilla was performed. By conserving the right gastric artery, 5 to 7 cm of the first portion of the duodenum is preserved with good arterial circulation. In addition, by conserving the anterior inferior pancreaticoduodenal artery, the third portion and anal side of the second portion of the duodenum are preserved with good arterial circulation. Resection of the pancreatic head with 3 to 4 cm of segmental duodenectomy including minor and major papilla completes this procedure. Reconstruction of the alimentary tract is then performed with pancreatogastrostomy, end to end duodenoduodenostomy and end to side choledochoduodenostomy.
RESULTS
In 14 cases of pancreatic head diseases, chiefly benign tumors, this procedure was successfully performed without severe complications. Postoperative quality of life was quite satisfactory.
CONCLUSION
Using this procedure, complete resection of the pancreatic head for benign tumor of the pancreatic head region can be performed safely and effectively.