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目的总结保留十二指肠的胰头切除术(DPPHR)在治疗胰头良性和低度恶性病变的经验。方法回顾性分析我院1998年5月至2010年3月施行该术式12例患者临床资料。尽量靠近胰十二指肠动脉弓弧形切除十二指肠内侧胰腺组织,并完整切除钩突,间断严密缝合十二指肠缘残留胰腺组织并以胰后被膜覆盖缝合。为了保留胰内段胆总管,必要时切开胆总管置入探条引导。结果无手术死亡。术后发生胰瘘2例,经非手术治疗后痊愈。无胰腺假性囊肿及腹腔脓肿形成。术后12例患者均随访半年以上,无术后糖尿病、胆总管狭窄、慢性消化不良发生,1例囊腺癌患者术后3个月出现肿瘤复发。结论对于胰头良性病变,DPPHR是一种安全、有效的手术方式。
Objective To summarize the experience of preserving the duodenum with pancreatic head resection (DPPHR) in the treatment of benign and malignant lesions of the pancreas. Methods A retrospective analysis of our hospital from May 1998 to March 2010 implementation of the operation of 12 cases of clinical data. As far as possible close to the pancreaticoduodenal arcuate resection of medial duodenum pancreatic tissue, and complete removal of uncinate process, intermittent sutured duodenal edge of the residual pancreatic tissue and the pancreatic membrane covered suture. In order to retain the common bile duct in the pancreas, if necessary, open the common bile duct into the guide. The result was no operative death. 2 cases of pancreatic fistula occurred after surgery, recovered after non-surgical treatment. No pancreatic pseudocyst and abdominal abscess formation. Twelve patients were followed up for more than six months without postoperative diabetes, common bile duct stenosis and chronic dyspepsia. One case of cystadenocarcinoma developed tumor recurrence 3 months after operation. Conclusion For benign pancreatic head disease, DPPHR is a safe and effective surgical method.