探讨胰腺中段切除术治疗胰腺良性及低度恶性肿瘤的临床应用价值。

本研究回顾性分析2006年1月至2011年12月在中山大学孙逸仙纪念医院普外科接受胰腺中段切除术，且术后病理诊断为良性或低度恶性肿瘤的23例患者临床资料。其中男9例，女14例；年龄16~59岁，中位年龄46岁。胰岛素瘤5例，实性假乳头状瘤4例，黏液性囊腺瘤4例，浆液性囊腺瘤3例，导管内乳头状黏液瘤3例，胰腺囊肿2例，无功能内分泌肿瘤1例和血管瘤1例。所有患者均签署知情同意书，符合医学伦理学规定。患者在气管插管全身麻醉下行胰腺中段切除术，于肿块两侧约1 cm处分别切断胰腺，胰腺近端行U型缝合或褥式缝合关闭，主胰管单独结扎，胰腺远端行胰腺-胃吻合或胰腺-空肠吻合。观察患者术中出血量、输血情况、手术时间，术后血糖水平、胰瘘发生情况。患者术后接受随访，随访内容包括肿瘤复发、生活质量、血糖水平。

患者术中出血量50~400 ml，中位出血量159 ml；术中输血1例；手术时间149~386 min，中位时间225 min。本组患者无发生严重并发症，术后血糖水平升高者1例，经对症治疗后缓解。本组患者11例（48%）发生胰瘘，其中A级胰瘘10例，B级胰瘘1例。A级胰瘘无需处理自愈，B级胰瘘经腹腔冲洗和抗感染后治愈。术后随访时间6个月~5年，中位时间23个月。随访期间失访1例，其余22例患者均存活，无肿瘤复发。1例患者术后6个月出现血糖升高，口服降糖药1年后停药，血糖维持正常水平。3例患者体重半年内无法恢复至术前水平，但无消化不良症状，且均未使用外源性胰酶替代药物。

对于胰腺良性及低度恶性肿瘤的患者，胰腺中段切除术是一种安全、合理的手术方式。

To explore the clinical application value of central pancreatectomy in the treatment of benign and low-grade pancreatic malignant neoplasms.

Clinical data of 23 patients (9 males, 14 females, age range: 16-59 years old, median age: 46 years old), who underwent central pancreatectomy and were diagnosed as benign or low-grade malignant neoplasms by postoperative pathological examinations in Department of General Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2006 to December 2011 were retrospectively analyzed. Five cases were insulinomas, 4 cases were solid pseudopapillary tumors, 4 cases were mucinous cystadenomas, 3 cases were serous cystadenomas, 3 cases were intraductal papillary mucinous tumors, 2 cases were pancreatic cysts, 1 case was nonfunctioning endocrine tumor and 1 case was hemangioma. The informed consents of all patients were obtained and the ethical committee approval was received. All patients received central pancreatectomy under tracheal intubation general anesthesia. The pancreas was transected about 1 cm away from both sides of neoplasm. The proximal end of pancreas was closed by U shape-suture or mattress-suture, and the main pancreatic duct was ligatured separately. The distal end of pancreas was anastomosed with stomach or jejunum. The volume of intraoperative blood loss, blood transfusion, operation length, postoperative blood glucose level and pancreatic fistula were observed. The patients were followed up after operation about tumor recurrence, quality of life and blood glucose level.

The median volume of intraoperative blood loss was 159 ml(50-400 ml). One case received blood transfusion during operation. The median operation length was 225 min(149-386 min). No severe complication was observed in all patients. Elevated blood glucose level was found in 1 case after operation and remitted after symptomatic treatment. Pancreatic fistula was found in 11 cases(48%) with 10 cases of grade A pancreatic fistula and 1 case of grade B pancreatic fistula. The patients with grade A pancreatic fistula were self-cured without any treatment. The patient with grade B pancreatic fistula was cured by peritoneal lavage and anti-infective treatment. The postoperative follow-up length was 6 months to 5 years with the median of 23 months. One case was lost to follow-up, the other 22 cases survived without tumor recurrence. One case suffered from elevated blood glucose level 6 months after operation. The patient received oral hypoglycemic agents for 1 year and then stopped, the blood glucose level was kept normal. Three cases failed to regain body weight within half a year after operation, but no symptoms of dyspepsia were observed and no exogenous pancreaticenzyme replacement was used.

Central pancreatectomy is a safe and reasonable procedure for patients with benign or low-grade pancreatic malignant neoplasms.