Deng Yuhua,Zhang Mingman,Guo Hongling,et al.Clinical analysis of 4 cases of children undergoing pancreaticoduodenectomy[J].Journal of Clinical Pediatric Surgery,2019,18(06):498-502.[doi:10.3969/j.issn.1671-6353.2019.06.012]
4例儿童胰十二指肠切除术的临床疗效分析
- Title:
- Clinical analysis of 4 cases of children undergoing pancreaticoduodenectomy
- Keywords:
- Pancreaticoduodenectomy; Treatment Outcome; Child
- 分类号:
- R726.1;R735.9
- 摘要:
- 目的 总结4例儿童胰十二指肠切除术(pancreaticoduodenectomy,即Whipple术)的手术技巧及监护治疗经验,讨论该术式在儿童中的可行性并总结术后监护的成功经验。方法 回顾性分析2016年10月至2018年1月由重庆医科大学附属儿童医院行Whipple术患儿的临床资料,共4例,其中男童2例,女童2例;中位年龄6岁6个月,疾病分别为胰腺实性假乳头状瘤1例、胰母细胞瘤1例、胆管葡萄状胚胎性横纹肌肉瘤1例和B细胞淋巴母细胞瘤1例。结果 4例患儿均顺利完成胰十二指肠切除术。主要临床表现为腹痛,以上腹部为著,其中3例合并黄疸,1例合并便血。CT检查均提示累及胰腺头部的实性占位,并通过手术证实。肿瘤直径4~10 cm,1例合并淋巴结转移,1例合并门静脉瘤栓。术后出现不完全性肠梗阻1例。随访3~18个月,均未发现肿瘤复发及转移。结论 儿童年龄不是Whipple术的禁忌证,该术式治疗儿童累及胰腺的病变是安全可行的,术前MRI及CT检查可为手术提供安全支持,手术术式的选择应依据术前CT和术中对肿瘤部位、包膜是否完整、是否侵及周围组织的评估结果来决定,术后加强液体平衡监测及及时补液可以降低并发症的发生率。
- Abstract:
- Objective To review the clinical data of 4 cases of Wipple’s procedure and summarize the experience of surgical techniques and monitoring. Methods Retrospective analysis was performed for the clinical data of 4 children undergoing Wipple’s procedure from October 2016 to January 2018.Among them,there were 2 boys and 2 girls with a median age of 78 months.The etiologies were solid pseudopapillary pancreatic tumor,pancreatic blastoma,bile duct grape-embryonic rhabdomyosarcoma and B lymphoblastic neoplasms respectively.Results Wipple’s procedure was performed successfully.The major clinical manifestation was abdominal pain,especially in upper abdomen.There were jaundice (n=3) and hematochezia (n=1).The findings of computed tomography (CT) were solid space-occupying of pancreatic head and were confirmed intraoperatively.Tumor had a diameter of 4 to 10 cm.Among them,there were lymph node metastasis (n=1) and portal vein tumor thrombus (n=1).Incomplete bowel obstruction occurred in 1 child after operation.No recurrence or metastasis occurred during a follow-up period of 3 to 18 months. Conclusion It is both safe and feasible to treat children with pancreatic mass by Whipple procedure.Preoperative magnetic resonance imaging (MRI) and CT provide strong preoperative supports.The choice of surgical procedures should be based on locations,with or without intact capsule and invading the surrounding tissues.Postoperative fluid monitoring and prompt rehydration may reduce the incidence of complications.
参考文献/References:
1 Senthilnathan P,Patel N,Nalankilli VP,et al.Laparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas:case report[J].Pancreatology,2014,14(6):550-552.DOI:10.1016/j.pan,2014,14(6):550-552.
2 Arya VB,Senniappan S,Demirbilek H,et al.Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism[J].PLoS One,2014,9(5):e98054.DOI:10.1371/journal.pone.0098054.
3 D’ambrosio G,Del Prete L,Grimaldi C,et al.Pancreaticoduodenectomy for malignancies in children[J].J Pediatr Surg,2014,49(4):534-538.DOI:10.1016/j.jpedsurg.2013.09.010.
4 Deoliveira ML,Winter JM,Schafer MA,et al.Assessment of complications after pancreatic surgery-A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy[J].Ann of Surg,2006,244(6):931-939.DOI:10.1097/01.sla.0000246856.03918.9a.J Gastrointest Surg.
5 Reid-Lombardo KM,Farnell MB,Crippa S,et al.Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients:a report from the Pancreatic Anastomotic Leak Study Group[J].J Gastrointest Surg,2007,11(11):1451-1458; discussion 1459.DOI:10.1007/s11605-007-0270-4.
6 朱友国,吴飞跃,罗嘉,等.胰十二指肠切除术后并发症的分析[J].中国普通外科杂志,2011,20(3):306-308. Zhu YG,Wu FY,Luo J,et al.Analysis of postoperative complications of pancreaticoduodenectomy[J].Chin Jo Gen Surg,2011,20(3):306-308.
7 Testini M,Piccinni G,Lissidini G,et al.Surgical management of the pancreatic stump following pancreato-duodenectomy[J].Journal of Visceral Surgery,2016,153(3):193-202.DOI:10.1016/j.jviscsurg.2016.04.003.
8 Kapoor VK.Complications of pancreato-duodenectomy[J].Rozhl Chir,2016,95(2):53-59.
9 Tsai S,Choti MA,Assumpcao L,et al.Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer:a large single-institution study[J].J Gastrointest Surg,2010,14(7):1143-1150.DOI:10.1007/s11605-010-1201-3.
10 Venkat R,Puhan MA,Schulick RD,et al.Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy a novel scoring system[J].Arch Surg,2011,146(11):1277-1284.DOI:10.1001/archsurg.2011.294.
11 冯业晨,王敏,秦仁义.胰腺吻合新理念与新技术[J].临床肝胆病杂志,2016,32(5):867-869.DOI:10.3969/j.issn.1001-5256.2016.05.009. Feng YC,Wang M,Qin RY.New thoughts and techniques in pancreatic anastomosis[J].J Clin Hepatol,2016,32(5):867-869.DOI:10.3969/j.issn.1001-5256.2016.05.009.
12 Abu-El-Haija M.Lin TK,nathan JD.management of acute pancreatitis in children[J].Curr Opin Pediatr,2017,29(5):592-597.DOI:10.1097/MOP.0000000000000528.
13 Iovanna J,Mallmann MC,Gonçalves A,et al.Current knowledge on pancreatic cancer[J].Front Oncol,2012;2:6.DOI:10.3389/fonc.2012.00006.
14 孙波,刘经雷,李炜.136例胰十二指肠切除术的治疗体会[J].徐州医学院学报,2015,35(12):877-879.DOI:10.4293/108680813X13654754534792. Sun B,Liu XL,Li H.Experience in the treatment of 136 cases of pancreaticoduodenectomy[J].Actad Academiae Medicinae Xuzhou.2015,35(12):877-879.DOI:10.4293/108680813X13654754534792.
15 Mandell MS,Hang Y.Pro:early extubation after liver transplantation[J].J Cardiothorac Vasc Anesth,2007,21(5):752-755.DOI:10.1053/j.jvca.2007.07.009.
16 郭一滨,范萍,皋岚湘.小儿胰腺实性-假乳头状瘤:附2例报告[J].临床小儿外科杂志,2003,2(5):340-342.DOI:10.3969/j.issn.1671-6353.2003.05.008. Guo YB, Fan P, Gao LX.A report of 2 cases of solid-pseudopapillary tumor of pancreas in young children and literatures review[J].J Clin Ped Sur,2003,2(5):340-342.DOI:10.3969/j.issn.1671-6353.2003.05.008.
17 姜辉,孙百胜,杜海峰,等.MRI误诊小儿胆管胚胎性横纹肌肉瘤并文献复习[J].临床误诊误治,2012,25(4):103-104.DOI:10.3969/j.issn.1002-3429.2012.04.046. Jiang H,Shun BS,Dui HF,et al.Misdiagnosis of biliary embryonal rhabdomyosarcoma in children with MRI and literature review[J].Clinical Misdiagnosis & Mistherapy,2012,25(4):103-104.DOI:10.3969/j.issn.1002-3429.2012.04.046.
相似文献/References:
[1]何联杨星海陈海涛.156例小儿精索静脉曲张的临床分析[J].临床小儿外科杂志,2011,10(01):0.
[2]汪兵 苗武胜 张亮 吴永涛 张博浩.克氏针张力带固定治疗儿童陈旧性肱骨外髁骨折的疗效观察[J].临床小儿外科杂志,2011,10(03):176.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):176.
[3]刁美 林海伟 明安晓 李龙 郑伟. 腹腔镜与开放性肝管空肠吻合术治疗先天性[J].临床小儿外科杂志,2011,10(05):325.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):325.
[4]周维 李娟 黄国显 陈海琛 胡杨 徐延波. Snodgrass及Mathieu术式治疗前型尿道下裂的对比分析[J].临床小儿外科杂志,2011,10(05):364.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):364.
[5]段光琦 毕允力 张敏 管肖浩. Koyanagi手术和改良手术治疗重型尿道下裂[J].临床小儿外科杂志,2011,10(05):389.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):389.
[6]蒋璐杏 刘少红 陈朝辉 李绿容. 造口护肤粉与皮肤保护膜联合应用于小儿肠造瘘周围皮炎的疗效观察[J].临床小儿外科杂志,2011,10(05):398.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):398.
[7]杜真 张溪英 朱诗利 王江平 刘晶晶 邝日裕. 复方利多卡因乳膏在小儿全麻气管插管中的应用[J].临床小儿外科杂志,2011,10(06):461.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):461.
[8]张金山 李龙 侯文英 刘树立 刁美 李胜利 明安晓 刘垚 王海滨. 影响胆总管囊肿手术疗效的因素分析[J].临床小儿外科杂志,2012,11(01):7.
[9]贾炜 余家康 钟微 李瑞琼 何秋明 夏慧敏. 先天性食管闭锁12年疗效评价[J].临床小儿外科杂志,2012,11(01):20.
[10]彭荣 杨星海 张伊 凡丁锋 黄姗. 先天性肠闭锁352例诊治体会[J].临床小儿外科杂志,2012,11(01):45.
备注/Memo
收稿日期:2018-06-07。
基金项目:重庆市科技计划项目(编号:cstc2014yykfA110014)
通讯作者:张明满,Email:zhangmingman-a@163.com