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Middle Segment Pancreatectomy for the Benign Tumors of the Neck and Body of the Pancreas (Report of 12 Cases)

Author: WangXiaoDong
Tutor: ZhangXueWen
School: Jilin University
Course: Surgery
Keywords: middle segment pancreatectomy benign tumor pancreatic fistula surgical treatment pancreas exocrine and endocrine function the blood supply
CLC: R735.9
Type: Master's thesis
Year: 2009
Downloads: 61
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Objective: To investigate the clinical value of the middle segment pancreatectomy in the benign tumors of the neck for body of the pancreas.Methods: 12 cases receiving the middle segment pancreatectomy because of the benign tumors of the neck the body of the pancreas in the hepatopancreato-biliary department of Jilin University China-Japan Union Hospital between November 2005 and December 2008 were retrospectively analyzed. Among the 12 cases, there were 2 males, 10 females, aged between 31 and 55 years old, averaging 45 years old. Preoperatively, blood CA19-9 and CEA examination were all in the normal range. There were 2 cases with diabetes mellitus, among 1 case the expansion of pancreatic duct end had prompted through imaging findings and urine amylase also was 3 times higher than normal. Preoperatively, all cases were diagnosed the benign tumors of the neck and body of the pancreas by pancreatic ultrasound, among them 8 cases were considered pancreatic cystadenoma, 2 cases were pancreatic pseudocyst, 1 case was pancreatic cysts, but true cysts or pseudocysts could not be determined, 1 case was solid-pseudopapillary tumor of the pancreatic body. All cases further received pancreatic CT scan and enhanced CT scan, according to CT findings, 11 cases were considered cystic neoplasm of the neck and body of the pancreas, among 11 cases 8 cases were considered pancreatic cystadenoma, 3 cases were cystic pancreatic tumors, but true cysts or pseudocysts could not be determined, and the remaining 1 case was considered solid-pseudopapillary tumor in the body of the pancreas. 1 case was considered pancreatic cystadenoma through further endoscopic ultrasound (EUS), but the end of common bile duct was showed unclearly through preoperative CT examination because of the mass attaching to the side of pancreatic head. There are 2 cases with the expansion of pancreatic duct in the tail preoperatively through ultrasonography and CT. The anastomosis types of middle segent pancreatectomy include 11 cases with routine ligation of proximal main pancreatic duct, ends locking suture; Roux-en-Y anastomosis distal between pancreas and jejunal (single-anastomosis); 1 case with routine ligation of main pancreatic duct near the pancreatic head, near cut-side and remote jejunum "?" anastomosis (double anastomosis).Results: No in-hospital death occurred. Mean tumor size was 5.5 cm and mean operative time was 240 minutes with a mean blood loss of 400 ml. Only 2 cases received blood transfusion. Average postoperative length of stay was 14.5 days. Pathologically, it was pancreatic Solid-pseudopapillary tumor in 1 case, nonfunctioning islet cell tumor in 2 cases, pancreatic serous cystadenoma in 7 cases and mucinous cystadenoma in 2 cases. Postoperative pancreatic fistula occurred in 3 cases(25%), of which 1 case of combined intra-abdominal infection. Pancreatic fistula occurred in 2 cases were healed in hospital. 1 case who occured pancreatic fistula discharged from hospital on postoperative day 14 with drainage tube, and the drainage tube was removed and fistula were healed by postoperative 3 months. There was no mortality or new-onset diabetes mellitus. 2 cases with diabetes mellitus didn’t worsen after surgery, and insulin dosage of 1 case decreased 8u/d compared with preoperation. In our department the incidence of pancreatic fistula in the middle segment pancreatectomy was higher than pancreaticoduodenectomy at the same period , (P <0.05, there is statistical significance); and compared with pancreaticosplenectomy, the incidence of the pancreatic fistula in the middle segment pancreatectomy was also high, but there is no statistical significance (P> 0.05). 12 cases were all followed up for 2-39 months, averaging 25 months. The quality of all cases’life are well, 11 cases of body weight gross return to the preoperative level or more than preoperation;1 case had the diarrhea after eating fat, but after oral pancreatin tablets, the symptom of diarrhea gradually eased. There was no recurrence and no formation of pancreatic pseudocyst after pancreatic fistula cured. Conclusion:1. It is feasible that middle segment pancreatectomy treat the pancreatic benign tumors of the neck and body in the view of anatomy. And the clinical effect is Satisfactory. It can be used as the first choice.2. Compared with traditional pancreaticoduodenectomy, there is a higher incidence of pancreatic fistula in the middle segment pancreatectomy, but as long as the drainage is unobstructed, it will be mostly self-healed.3. In the middle segment pancreatectomy, small pancreatic tissue is resected with the spleen and duodenum retained. The operation impacts on the pancreatic exocrine and endocrine function lightly resulting in the higher quality of life.

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