目的 用保留十二指肠水平段的胰十二指肠切除术及Roux-Y同步吻合重建消化道的方法，达到降低手术并发症，促进患者恢复，提高其生存质量和时间。方法 在行胰十二指肠切除术时，保留十二指肠水平段、升段、屈氏韧带及空肠上段，用RouxY同步吻合的方法将胰、胆、胃、肠重建排列，术后胆肠吻合口不置T管及空肠不置造瘘管，腹腔置2 mm硅胶管用于灌洗。结果 28例中除2例切口裂开，行二期缝合外，均顺利恢复出院。平均住院25天。无胆、胰漏，无返流性胆管、胰管炎等。随访6个月~6年，1年生存24例（85.7%），3年生存15例（53.6%），5年生存5例（17.9%）。结论 保留十二指肠水平段，消化功能恢复快，不影响根治时相关淋巴结的廓清。用Roux-Y同步吻合重建消化道，并发症少。不置T管和空肠造瘘管，对患者侵扰小，恢复快，提高了患者生存率。
ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.
ObjectiveTo compare the perioperative outcomes of laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) and minimally invasive enucleation (MIEN) in the treatment of benign or low-grade malignant tumors of the pancreatic head. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent LDPPHR (n=30) and MIEN (n=38) at Fudan University Shanghai Cancer Center between March 2021 and November 2024. The perioperative outcomes of the LDPPHR and MIEN groups were compared. Preoperative assessment of tumors in the MIEN group showed that they were partially or completely encircling the main pancreatic duct. ResultsThe MIEN group had a significantly shorter operative time compared to the LDPPHR group (229.0 min vs. 388.5 min, P<0.001), with less intraoperative blood loss (100.0 mL vs. 200.0 mL, P=0.028). Regarding the management of the main pancreatic duct, 26.3% (10/38) of patients in the MIEN group had an intact and unexposed main pancreatic duct, 10.5% (4/38) had exposed but undamaged ducts, 7.9% (3/38) had duct injury repaired with simple suture, and 55.3% (21/38) required stenting for duct repair and reconstruction following injury. Although the incidence of postoperative pancreatic fistula was higher in the MIEN group compared to the LDPPHR group [grade B: 73.7% (28/38) vs. 43.3% (13/30)], no significant differences were observed between the two groups in other perioperative outcomes (such as postoperative length of stay, discharge rate with drainage tube, and Clavien-Dindo complication grading, all P>0.05). One patient in the MIEN group required reoperation due to early postoperative hemorrhage. ConclusionsMIEN is a feasible surgical option for treating benign or low-grade malignant pancreatic head tumors with involvement of the main pancreatic duct. It shows significant advantages, particularly in terms of preserving organ function and maintaining normal anatomical structures. Despite the higher incidence of pancreatic fistula, no significant differences were observed in other perioperative outcomes compared to LDPPHR. Therefore, MIEN holds great promise in the treatment of pancreatic head tumors, especially for younger patients with a strong desire for function preservation.
Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
ObjectiveTo explore the clinical efficacy and summarize the experience of intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt). MethodThe clinical data of patients (from April 2020 to June 2024), including preoperative, intraoperative, and postoperative details who underwent LDPPHRt in Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected and analyzed. ResultsSeventy-five patients were collected in this study, including 35 males (46.7%) and 40 females (53.3%). The age was (38.3±7.9) years old, and 35 patients (46.7%) presented without symptoms. The main symptoms were abdominal pain (21 cases, 28.0%), repeated diarrhea (15 cases, 20.0%), weight loss (4 cases, 5.3%). The diameter of the pancreatic head lesions was (3.2±0.8) cm. The operative time was (210.6±23.8) min, and the blood loss was (62.4±38.1) mL. There were 18 cases (24.0%) of postoperative complications, including 6 cases (8.0%) of postoperative pancreatic fistula, 5 cases (6.7%) of haemorrhage, 4 cases (5.3%) of biliary leakage, 2 cases (2.7%) of lymphatic leakage, 4 cases (5.3%) of delayed gastric emptying, 2 cases (2.7%) of abdominal infection, 1 case (1.3%) of pulmonary infection and 2 cases (2.7%) of wound infection. The length of postoperative hospital stay was (11.7±3.3) d, and no one died within 90 d after surgery. ConclusionsThe intracapsular approach is a feasible and safe surgical procedure in LDPPHRt for patients with benign, borderline or low grade malignant tumors.
ObjectiveTo explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. MethodThe related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. ResultsThe effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. ConclusionDPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.
ObjectiveTo evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. MethodsA retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). ResultsAll 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. ConclusionsLDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.
The surgical treatment of chronic pancreatitis, benign, borderline and low-grade malignant tumors of the pancreatic head is definite in effect. How to preserve more functional organs is the focus of such surgeries. The duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR) surgical method pioneered by the author team has theoretical advantages compared to other surgical methods. However, due to the difficulty of surgical operation and higher requirements for surgeons, its widespread application is limited. By elaborating on the invention principle and evolution process of this surgery, analyzing the key steps in detail and showing the clinical effects, the author proves that DCOPPHTR is safe and effective and has higher clinical application value.
ObjectiveTo estimate the prognosis of duodenum-preserving resection of pancreatic head (DPRPH) in the treatment of space occupying with extensive calcification of pancreatic head, and to summarize the key points of surgery.MethodsThe clinical data of a middle-aged woman with rare space occupying with extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed.ResultsThe DPRPH operation was successfully completed, with the operative time was 207 min, the intraoperative blood loss was 130 mL, and the hospital stay was 12 d. Removing time of the gastric tube and off-bed activity were on the 3rd day after operation, and the volume of peritoneal drainage per day was decreasing from 30 mL to 10 mL until 7th day after operation. We made examination of serum amylase and fluid amylase for the patient every 2 days, and the examination indexes were within normal level. After removing the peritoneal drainage tube, the pain was obviously relieved on the 12th day after operation, then the patient made hospital discharge. There was no observable pancreatic fistula, duodenal fistula, biliary fistula, delay gastric emptying, peritoneal effusion, pleural effusion, abdominal infection, and abdominal bleeding, neither nor any special discomfort. During the follow-up period of 18 months, we got a good prognosis without any symptom of relapse or discomfort according to the result of CT scans and other examinations.ConclusionDPRPH can make a satisfied prognosis in the treatment of rare space occupying with extensive calcification of pancreatic head.