Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

作     者：W Kyle Mitchell Pradeep F Thomas Abed M Zaitoun Adam J Brooks Dileep N Lobo 

作者机构：Gastrointestinal SurgeryNottingham Digestive Diseases CentreNational Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of NottinghamQueen's Medical Centre Cellular PathologyNottingham Digestive Diseases CentreNational Institute for Health Research Nottingham Biomedical Research CentreNottingham University Hospitals and University of NottinghamQueen's Medical Centre 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第23期

页      面：4252-4261页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Pancreas preserving distal duodenectomy Duodenojejunostomy Duodenal disease Surgical technique Adults Indications Treatment Outcome 

摘      要：To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of *** lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also ***-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PP