Pancreaticoduodenectomy

胰十二指肠切除术主要用于治疗壶腹周围肿瘤，标准的切除范围包括胰头及钩突、十二指肠、胆总管、胆囊、远端胃及近端空肠，还需常规行胰头周围淋巴结清扫（包括第6、8、12、13、14、17组淋巴结），消化道重建包括胰空肠、胆管空肠及胃空肠吻合。该手术创伤大，术后并发症发生率较高达20％～40％。手术要点包括完整的胰腺钩突切除、规范的淋巴结清扫及满意的胰腺空肠吻合。本例患者为60岁女性，术前诊断为梗阻性黄疸、胆总管癌。行标准的胰十二指肠切除术，消化道重建采用Child顺序，胰腺空肠套入式吻合。手术用时4．3 h，出血约200 ml，未输血。术后患者恢复顺利，无并发症，术后2周出院。术后病理为胆总管下段中分化腺癌，淋巴结共22枚均无转移。Pancreaticoduodenectomy ( Whipple 's procedure ) is mainly used for treatment of periampullary tumors. The classical extent of resection includes the pancreatic head, uncinate process, duodenum, common bile duct, gallbladder, distal stomach, and proximal jejunum, with a regular clearance of the lymph nodes around the head of pancreas (including group 6, 8, 12, 13, 14, and 17).The reconstructions of the digestive tract include pancreatic-jejunumanastomosis, cholangio-jejunostomy and gastro-jejunostomy. The postoperative complication rate is still as high as 20%-40%.The key points of this procedure include the complete resection of the uncinate process, standardized lymph node clearance, and satisfied pancreatic-jejunumanastomosis.In this article, we introduced a 60-year-old woman with a preoperative diagnosis of obstructive jaundice caused by common bile duct carcinoma.A standard Whipple procedure was performed for her, with an end-to-side invagination pancreaticojejunostomy.The duration of operation was 4 hours and 30 minutes, and blood loss was 200 ml without transfusion.The patient recovered uneventfully without any complication, and was discharged 2 weeks after surgery.The pathologic results showed a moderately differentiated adenocarcinoma of the distal common bile duct , and no metastasis was found among the 22 resected lymph nodes.国家自然科学基金资助项目中国科技核心期刊(ISTIC)4253-25