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胰十二指肠切除是治疗胰头壶腹部肿瘤的传统术式,但术后胰瘘等并发症直接影响着手术效果.为此我们1994年7月～1998年8月开展了胰头体部切除的胰腺次全切除术,治疗胰头壶腹部肿瘤17例,取得了满意的临床效果,报告如下.1 材料和方法1.1 一般资料 男11例,女6例,年龄40～77岁.胰头癌7例(均为Ⅰ、Ⅱ期),胰头囊肿1例,壶腹部癌9例.1.2 手术方法 进腹探查肿瘤能够切除后,切除胃远端50%,胆总管下段及胆囊、全部十二指肠及十二指肠韧带下10cm空肠、胰腺大部,仅保留胰尾5cm.在切除胰腺时,要特别注意钩突及胰体近胰尾处的小血管,仔细分离逐次切断结扎,避免损伤脾静脉造成大出血.常规横断胰颈,向两侧分离胰头体部,同时清除相应区域的淋巴结.Machad ofkasai消化道重建术,即将近段空肠与残胰于结肠后做对端套迭吻合,再于吻合口的远端25cm处截断空肠,将胆总管与空肠远切端于结肠后做对端或端侧吻合,然后将空肠近切端与距胆肠吻合口远侧25cm的肠管做Y型端侧吻合,残胃再与此Y型吻合远侧20cm处的空肠做结肠后吻合完成消化道重建.于胰肠胆肠吻合口处放引流管于侧腹壁引出.
Pancreatoduodenectomy is a traditional surgical procedure for the treatment of pancreatic head ampullary tumors. Postoperative pancreatic fistula and other complications directly affect the surgical outcome. For this reason, we performed the pancreatic head body from July 1994 to August 1998. Resection of pancreatic subtotal resection, treatment of 17 cases of pancreatic head ampulla tumors, achieved satisfactory clinical results, the report is as follows. 1 Materials and Methods 1.1 General Information 11 males and 6 females, aged 40 to 77 years old. 7 cases of cancer (all stage I and II), 1 case of pancreatic head cyst and 9 cases of ampullary carcinoma. 1.2 Surgical methods for exploration into the abdomen After the tumor can be removed, the distal part of the stomach is removed 50%, the lower common bile duct and the gallbladder, and all 10 The 10cm jejunum and most of the pancreas under the duodenal and duodenal ligament retain only the pancreas tail 5cm. When removing the pancreas, special attention should be paid to the uncinate process and the small blood vessels at the pancreatic end of the pancreas. Carefully separate and cut the ligation successively. Avoid damage to the splenic vein caused by large hemorrhage. Conventional transection of the pancreatic neck, the pancreatic head body to both sides, while removing the corresponding area of lymph nodes. Machad ofkasai digestive tract reconstruction, the proximal jejunum and residual pancreas in the colon after the end of the nesting Anastomosis, and then cut off the jejunum at the distal end of the anastomosis 25cm, distal to the common bile duct and jejunum After the colon to do the end or end of the anastomosis, and then the proximal end of the jejunum and the bile from the anastomosis distal 25cm intestine do Y-shaped end-to-side anastomosis, residual stomach and then the Y-type anastomosis distal 20cm at the colon to do the colon After anastomosis to complete the reconstruction of the digestive tract. In the pancreatic intestinal biliary anastomosis at the drainage tube placed on the lateral abdominal wall leads.