中国普外基础与临床杂志

中国普外基础与临床杂志

全胰腺切除+脾切除术治疗胰腺癌

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目的 探讨全胰腺切除+脾切除术治疗胰腺癌的效果及安全性。 方法 回顾性分析青海大学附属医院肝胆胰外科收治的 1 例行全胰腺切除+脾切除治疗的全胰腺癌患者的术前临床资料、手术治疗过程及术后情况。 结果 结合患者术前病史、影像学及实验室检查结果考虑诊断为胰腺癌拟行胰十二指肠切除术,术中发现全胰腺质地较硬且考虑脾动静脉受侵,多次送病检均提示胰腺切缘阳性,遂改行全胰腺切除+脾切除术。术后病理诊断符合高-中分化导管腺癌,患者病情平稳后长期给予胰酶制剂口服、胰岛素皮下注射治疗,无严重并发症发生,恢复良好,随访至今 3 个月未见复发。 结论 随着手术技术的提高及术后管理的加强,全胰腺切除可作为胰腺癌的一种治疗方式仍是安全、可行的。

Objective To investigate safety and therapeutic effect of total pancreatectomy plus splenectomy for patient with pancreatic cancer. Methods The preoperative clinical data, surgical treatment, and postoperative conditions of 1 patient with pancreatic cancer who underwent the total pancreatectomy plus splenectomy in the Affiliated Hospital of Qinghai University in January 2018 were retrospectively analyzed. Results Combination of the patient clinical history, physical examination, laboratory and radiologic results, the patient was diagnosed with the pancreatic cancer. Then the patient underwent the Whipple procedure. During the operation, it was found that the texture of the pancreas was hard, and the spleen arteriovenous were considered to be invaded, and the multiple frozen section analysis during the operation showed that the surgical margin was positive. Eventually, the total pancreatectomy plus splenectomy was performed. The postoperative pathological analysis results revealed to the moderately differentiated tubular adenocarcinoma. When the condition of patient became stable, the pancreatin and insulin were required for long time. No severe complications occurred. The patient survived well after the surgery and no recurrence was observed for following-up of 3 months. Conclusion With improvement of surgical techniques and enhancement of postoperative management, total pancreatectomy can be used as a treatment for pancreatic cancer and it is still safe and feasible.

关键词: 胰腺癌; 全胰腺切除术; 脾切除术

Key words: pancreatic cancer; total pancreatectomy; splenectomy

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