目的

探讨全胰腺切除术治疗胰腺癌的安全性和疗效。

方法

回顾性分析2019 年6 月至2023 年3 月在广西医科大学第一附属医院行全胰腺切除术的4 例胰腺癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男1 例，女3 例；年龄58～71 岁，中位年龄62 岁。观察患者围手术期情况、术后并发症等。

结果

4 例患者均成功施行全胰腺切除术，均采用动脉先行路径的全胰腺切除术，其中2 例行开放保留脾脏的全胰腺切除，1 例行腹腔镜下保留脾脏的全胰腺切除，1 例行机器人辅助下联合脾脏切除的全胰腺切除。手术时间488～784 min，中位时间643 min；术中出血量200～900 ml，中位出血量400 ml。术后病理学检查示胰腺导管腺癌3 例，胰腺腺鳞癌1 例。术后发生脆性糖尿病4 例，采用胰岛素泵控制血糖，维持空腹血糖水平在5～8 mmol/L，同时需补充胰酶制剂，提供胰腺外分泌功能支持。无术后胃排空障碍、胆漏、腹腔出血病例。术后住院时间13.0～21.0 d，中位时间15 d；无术后30 d 内死亡病例。随访时间2.0～46.0 个月，中位时间40.5 个月。1 例术后4 个月死于酮症酸中毒；其余3 例血糖稳定，生活质量可接受，无肿瘤复发。

结论

在严格把握手术指征的情况下，全胰腺切除术是安全可行的，术后血糖长期管理和胃功能恢复是影响患者生活质量的重要因素。

Objective

To evaluate the safety and efficacy of total pancreatectomy in the treatment of pancreatic cancer.

Methods

Clinical data of 4 patients with pancreatic cancer who underwent total pancreatectomy in the First Affiliated Hospital of Guangxi Medical University from June 2019 to March 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 1 patient was male and 3 female， aged from 58 to 71 years， with a median age of 62 years.Perioperative status and postoperative complications were observed.

Results

Total pancreatectomy via the arterial route was successfully performed in all 4 patients， including 2 cases of open spleen-preserving total pancreatectomy， 1 case of laparoscopic spleen-preserving total pancreatectomy and 1 case of robot-assisted total pancreatectomy with spleen resection.The operation time was 488-784 min， with a median time of 643 min.Intraoperative blood loss was 200-900 ml， with a median blood loss of 400 ml.Postoperative pathological examination showed that 3 cases were diagnosed with pancreatic ductal adenocarcinoma and 1 case of pancreatic adenosquamous carcinoma.Postoperatively，4 patients developed brittle diabetes.Insulin pump was used to control the blood glucose level， and the fasting blood glucose level was maintained at 5-8 mmol/L.Meantime， pancreatin preparation was supplemented to support pancreatic exocrine function.No postoperative gastric emptying disorder， bile leakage and abdominal bleeding were reported.The length of postoperative hospital stay was 13.0-21.0 d， with a median time of 15 d.No patient died within postoperative 30 d.Postoperative follow-up time was ranged from 2.0 to 46.0 months，with a median time of 40.5 months.One case died of ketoacidosis at 4 months after operation.The remaining 3 cases obtained stable blood glucose levels， acceptable quality of life and no tumor recurrence.

Conclusions

Total pancreatectomy is safe and feasible treatment if surgical indications are properly managed.Long-term management of postoperative blood glucose level and recovery of gastric function are critical factors affecting patients’ quality of life.