中国普外基础与临床杂志

中国普外基础与临床杂志

胰头占位伴致密钙化的手术切除

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目的 评估保留十二指肠的胰头切除治疗胰头致密钙化占位的预后,总结手术要点。 方法 回顾性分析入四川大学华西医院胰腺外科于 2016 年 5 月收治的 1 例罕见的胰头占位伴致密钙化的中年女性患者的临床资料。 结果 患者切除手术顺利完成,手术时间 207 min,术中出血量约为 130 mL,术后住院时间为 12 d。患者于术后 3 d 拔除胃管并下床活动,每日腹腔引流量约为 30 mL,至术后 7 d 引流量减至 10 mL,拔除腹腔引流管。术后每 2 天复查血清学淀粉酶及体液淀粉酶浓度,指标均正常。患者术后未诉特殊不适,术后无明显胰瘘、十二指肠瘘、胆汁漏、胃排空延迟、腹腔积液、胸腔积液、腹腔感染及腹腔出血发生。术后随访 18 个月,预后良好,无复发征象,无特殊不适。 结论 针对罕见的胰头占位伴致密钙化,行保留十二指肠的胰头切除可取得较好的预后。

Objective To estimate the prognosis of duodenum-preserving resection of pancreatic head (DPRPH) in the treatment of extensive calcification of pancreatic head, and to summarize the key points of surgery. Methods The clinical data of a middle-aged woman with rare extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed. Results The 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 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 were 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. Conclusion DPRPH can make a satisfied prognosis in the treatment of rare extensive calcification of pancreatic head.

关键词: 胰头占位; 胰头致密钙化; 保留十二指肠胰头切除; 预后

Key words: space occupying of pancreatic head; extensive calcification of pancreatic head; duodenum-preserving resection of pancreatic head; prognosis

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