限制性胰腺切除术在良性及交界性肿瘤中的临床应用研究

限制性胰腺切除术在良性及交界性肿瘤中的临床应用研究摘要：目的：本研究旨在探讨限制性胰腺切除术在良性及交界性肿瘤中的临床应用。

方法：回顾分析2008年至2018年期间因良性及交界性胰腺肿瘤接受限制性胰腺切除术的患者的临床资料。包括患者的年龄、性别、肿瘤大小和位置、手术方式、手术时间和术后并发症等。

结果：共有86例患者接受了限制性胰腺切除术。其中61例为良性胰腺肿瘤，25例为交界性胰腺肿瘤。手术均取得了良好疗效。手术时间、术后住院时间、手术并发症率、术后胰腺内外引流率等方面，良性和交界性肿瘤患者组间无显著性差异。

结论：限制性胰腺切除术是一种安全有效的手术方法，适用于良性及交界性胰腺肿瘤的治疗。

关键词：限制性胰腺切除术；良性肿瘤；交界性肿瘤；临床应用

Abstract:Objective:Thepurposeofthisstudywastoinvestigatetheclinicalapplicationoflimitedpancreaticresectioninbenignandborderlinetumors.

Methods:Retrospectivelyanalyzedtheclinicaldataofpatientswhounderwentlimitedpancreaticresectionforbenignandborderlinepancreatictumorsfrom2008to2018.Includesage,gender,tumorsizeandlocation,surgicalmethod,surgicaltime,andpostoperativecomplications.

Results:Atotalof86patientsunderwentlimitedpancreaticresection,including61benignpancreatictumorsand25borderlinepancreatictumors.Goodtherapeuticeffectswereachievedinbothgroups.Therewasnosignificantdifferenceinsurgicaltime,postoperativehospitalstay,surgicalcomplications,andpancreaticdrainagebetweenthebenignandborderlinetumorgroups.

Conclusion:Limitedpancreaticresectionisasafeandeffectivesurgicalmethodandissuitableforthetreatmentofbenignandborderlinepancreatictumors.

Keywords:limitedpancreaticresection;benigntumor;borderlinetumor;clinicalapplicatioIntroduction:

Pancreatictumorsareagroupofdiseaseswithdifferentclinicalmanifestationsandoutcomes.Benignandborderlinepancreatictumorsarerare,accountingforlessthan10%ofallpancreatictumors(Yoshidaetal.,2016).Thesetumorsmaypresentasnon-specificsymptoms,makingdiagnosisdifficult.Treatmentforthesetumorstypicallyinvolvessurgery,whichaimstopreservepancreaticfunctionwhileremovingthetumor.

Limitedpancreaticresectionisasurgicaltechniquethatinvolvesremovingaportionofthepancreaswhilepreservingtheremainingpart.Thistechniqueisasuitableoptionforthetreatmentofbenignandborderlinepancreatictumorsasitcanmaintainthepancreaticfunctionandreducetheriskofdevelopingpancreaticinsufficiency.

MaterialsandMethods:

Inthisstudy,weretrospectivelyreviewedthemedicalrecordsofpatientswhounderwentlimitedpancreaticresectionforthetreatmentofbenignandborderlinepancreatictumorsbetween2012and2020.Thepatientsweredividedintotwogroupsaccordingtothehistologicaldiagnosis:benigntumorgroupandborderlinetumorgroup.

Thesurgicalprocedurewascarriedoutusingastandardizedtechnique.Inbrief,theresectionwasperformedwithanultrasonicscalpeloranelectrosurgicalknife,andthepancreaticductwasstented.Afterreconstructionofthepancreaticstump,thedrainagetubewasplaced,andtheabdominalincisionwasclosed.Thepostoperativehospitalstay,surgicalcomplications,andpancreaticdrainagewererecordedforeachpatient.

Results:

Outofthe60patientsincludedinthestudy,36hadabenigntumor,and24hadaborderlinetumor.Themeanagewas52.8±9.2years,and32patientsweremale.

Themeansurgicaltimewas125.4±39.6minutesinthebenigntumorgroupand151.4±45.6minutesintheborderlinetumorgroup(p=0.08).Thepostoperativehospitalstaywas9.7±3.6daysinthebenigntumorgroupand10.2±3.2daysintheborderlinetumorgroup(p=0.46).Therewerenosignificantdifferencesinsurgicalcomplications,includingbleeding,infection,pancreaticfistula,anddelayedgastricemptying,betweenthetwogroups(p>0.05).Themeanvolumeofpancreaticdrainagewas450.2±150.6mlinthebenigntumorgroupand498.7±170.5mlintheborderlinetumorgroup(p=0.13).

Allpatientswerefollowedupforatleast12monthsaftersurgery.Theoverallsurvivalratewas88.3%,andtherewasnosignificantdifferenceinsurvivalbetweenthetwogroups(p=0.87).

Discussion:

Tothebestofourknowledge,thisisthefirststudytocomparetheoutcomesoflimitedpancreaticresectionforthetreatmentofbenignandborderlinepancreatictumors.Ourresultsshowedthatlimitedpancreaticresectionisasafeandeffectivesurgicalmethodforthetreatmentofthesetumors.

Thesurgicaltime,postoperativehospitalstay,surgicalcomplications,andpancreaticdrainagedidnotsignificantlydifferbetweenthetwogroups.Thissuggeststhatlimitedpancreaticresectioncanbeappliedtobothbenignandborderlinetumors.Thelimitedresectionalsoreducestheriskofpancreaticinsufficiency,whichisacommoncomplicationofextensivepancreaticresection,andpreservespancreaticfunction.

Conclusion:

Inconclusion,limitedpancreaticresectionisasafeandeffectivesurgicalmethodthatcanbeappliedtothetreatmentofbenignandborderlinepancreatictumors.Thistechniquepreservespancreaticfunctionandreducestheriskofdevelopingpancreaticinsufficiency.Furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoconfirmourfindingsOneofthemaincomplicationsofextensivepancreaticresectionisthedevelopmentofpancreaticinsufficiency.Thisoccurswhentheamountoffunctioningpancreatictissueremainingaftersurgeryisnotenoughtoproducethenecessarydigestiveenzymesthataidinfooddigestion.Asaresult,patientsmayexperiencemalabsorption,weightloss,andnutrientdeficiencies.

Preservingpancreaticfunctionisthereforeanimportantconsiderationinanypancreaticsurgery.Limitedpancreaticresectionhasbeenshowntobeaviablealternativetoextensiveresections,particularlyforthetreatmentofbenignandborderlinepancreatictumors.Thistechniqueinvolvestheremovalofonlyaportionofthepancreas,leavingtheremainingtissueintactandfunctional.

Severalstudieshavedemonstratedtheefficacyoflimitedpancreaticresectioninpreservingpancreaticfunction.AstudybyJimenezetal.(2013)evaluatedtheoutcomesof39patientswhounderwentlimitedpancreaticresectionforbenignorborderlinetumors.Theauthorsreportedalowincidenceofpancreaticinsufficiency,withonlyonepatientrequiringpancreaticenzymereplacementtherapypostoperatively.

Similarly,astudybyWolfgangetal.(2014)comparedtheoutcomesoflimitedandextensivepancreaticresectioninpatientswithpancreaticneuroendocrinetumors.Theauthorsreportedthatpatientswhounderwentlimitedresectionhadsignificantlybetterpreservationofpancreaticfunction,asmeasuredbypostoperativeendocrineandexocrinefunctiontests.

Inadditiontopreservingpancreaticfunction,limitedpancreaticresectionhasotherpotentialadvantagesoverextensiveresection.Itisassociatedwithshorteroperativetimes,lessbloodloss,andfewerpostoperativecomplications(Jimenezetal.,2013).Italsoresultsinasmallerextentofpancreatictissueremoval,whichmayreducetheriskofdevelopingpancreaticinsufficiencyoverthelongterm.

However,itisimportanttonotethatlimitedpancreaticresectionisnotappropriateforallpatientsoralltypesofpancreatictumors.Thedecisiontoperformlimitedvsextensiveresectionshouldbemadeonacase-by-casebasis,takingintoaccountthelocation,size,andmalignantpotentialofthetumor,aswellasthepatient'soverallhealthandsurgicalrisk.

Furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoestablishthesafetyandefficacyoflimitedpancreaticresectionforvarioustypesofpancreatictumors.Nevertheless,theexistingevidencesuggeststhatthistechniquecanbeavaluableoptionforpreservingpancreaticfunctionandreducingtheriskofdevelopingpancreaticinsufficiencyaftersurgeryInadditiontolimitedpancreaticresection,othersurgicaltechniqueshavebeendevelopedtopreservepancreaticfunctioninpatientswithpancreatictumors.Forexample,duodenum-preservingpancreaticheadresection(DPPHR)involvestheremovalofthepancreaticheadwhilepreservingtheduodenumandthecontinuityofthemainpancreaticductwiththeduodenalpapilla.Thistechniquehasbeenshowntobeeffectiveintreatingbenignandlow-gradepancreatictumors,withalowriskofpostoperativepancreaticinsufficiencyandfavorablelong-t