十二指肠切除术

objective: to summarize the clinical application of reservation of partial duodenum in pancreaticoduodenectomy.

目的：总结保留部分十二指肠在胰十二指肠切除术中的临床应用效果。

objectiveto investigate the diagnosis and treatment of traumatic duodenal rupture.methodthe clinical data of 13 patients with traumatic duodenal rupture hospitalized from may 1991 to december 2008 were retrospectively analyzed,and the material cause was automobile accident mainly.resultsin these 13 patients,after hospitalization,6 cases were diagnosed in 3 hours,4 cases were diagnosed in 24～72 hours,and 3 cases were diagnosed after 72 hours.three cases with duodenal cleft repair,2 cases with duodenal ostomy,2 cases with duodenum and jejunum roux-en-y anastomosis,1 case with duodenal diverticular surgery,1 case with meliorative duodenal diverticular surgery,1 case with duodenal broken ends closure and anastomosis of stomach with jejunum,1 case with duodenal distal closure and anastomosis of duodenal local with jejunum,and 2 cases with resections of pancreas duodenum.after the operation,6 cases (46.2%) appeared some complications of wound infection,duodenal fistula,digestive tract hemorrhage,pancreatic fistula,abdomen infection and so on.two cases (15.4%) died from multiple system organ failure and septic shock.conclusionthe early diagnosis and correct operation style selection are the keys for duodenal rupture.

目的：探讨外伤性十二指肠破裂的诊断和治疗方法。方法：回顾分析外伤性十二指肠破裂患者13例临床资料。结果：入院后3 h内确诊6例，24～72 h内确诊4例，72 h后确诊3例。3例行十二指肠裂口修补，2例行十二指肠造瘘，2例行十二指肠空肠roux-en-y吻合，1例行十二指肠憩室化手术，1例行改良十二指肠憩室化手术，1例行十二指肠两断端关闭、胃空肠吻合，1例行十二指肠远端关闭、近端与空肠端侧吻合，2例行胰十二指肠切除术。术后6例(46.2%)出现切口感染、十二指肠瘘、消化道出血、胰瘘或腹腔感染等并发症，2例(15.4%)患者死亡，分别死于多器官系统衰竭和感染中毒性休克。结论：早期诊断与正确的术式选择是成功救治外伤性十二指肠破裂的关键。

Mean tumor size was 4.2 cm, and multiple tumors were noted in 10 patients. Eight patients (25%) underwent pancreticoduedenectomy, and 25 patients (76%) underwent distal pancreatectomy (extended distal pancreatectomy in 4 and splenectomy in 20 patients).

肿瘤平均直径4.2cm，10名病人有多发肿瘤。8名病人（25%）接受胰十二指肠切除术，25名（76%）接受胰尾切除术（4例为扩大胰尾切除术，20例同时进行脾切除）。

Radical excision 153 cases,of which 128 cases in pancreatoduodenectomy,20 cases in the expansion of pancreatoduodenectomy,and 5 in total pancreatectomy; 102 cases with palliative operation,of which 33 cases in RouxY biliaryenteric anastomosis,69 cases in the Rouxen bridge T tube drainage.

根治性切除术153例中，胰十二指肠切除术128例，扩大胰十二指肠切除术20例，全胰切除术5例；姑息性手术102例中，胆肠RouxY吻合术33例，胆肠T管架桥内引流术69例。

The case number of duodenopancreatectomy,cholecystojejunostomy, cholecystoduodenostomy, gastrojejunostomy, cholecystostomy, choledochoduodenostomy, choledochjejunalostomy, exploration of the common bile duct, and T tube drain were 43, 20, 3, 19, 4, 4, 21, 18, 7 respectively.

行胰十二指肠切除术43例，胆囊空肠吻合术20例，胆囊十二指肠吻合术3例，胃空肠吻合术19例，胆囊造瘘术4例，胆总管十二指肠吻合术4例，胆总管空肠吻合术21例，胆总管探查、T管引流18例，剖腹探查术7例。

They were male in 8 eases and female in 14. Pancreatic cystoadenoma was in 14 cases (63.30%) and pancreatic cystoadenocarcinoma in 8(36.3%). It was 1.7:1 between two groups. Tumor at the head of pancreas was 6 cases (27.21%). at body-tail 12 (54.5%). at tail 4 (18.1%). Local resection was performed in one case, pancreatic body-tailectomy pancreatoc1uodenectoni in 3, central pancreatectomy in 2 cases.

男8例，女14例。14例(63.3%)为胰腺囊腺瘤（浆液性6例、黏液性8例），8例(36.3%)为胰腺囊腺癌，两者之比为1.7：l肿瘤位于胰腺头部6例(27.2%)，胰腺体尾部12例(54.5%)，胰腺尾部4例(181%)行胰腺肿瘤局部切除术l例，肤腺体尾部切除术14例，胰头十二指肠切除术3例，胰腺中段切除术2例，囊肿－空肠Roux-Y吻合术1例，T管架桥胆－肠内引流术1例。

Accurate operational evaluation and careful operation are also important for pancreatoduodenectomy combined vascular resection.

术中准确的评估，细致的解剖操作，对成功开展合并受侵血管切除的胰十二指肠切除术至关重要。

Complete resection was achieved in all cases, including pancreatoduodenectomy in 13 cases, by pylorus-preserving pancreatoduodenectomy in 3 cases, and tumor enucleation in 7 cases.

行胰十二指肠切除术13例，其中4例合并右半结肠切除术，1例合并右肝转移灶切除，2例合并右肝脓肿引流术；行保留幽门的胰十二指肠切除术3例；行肿瘤局部切除术7例。

Pancreatoduodenectomy is the routine operation performed for pancreas carcinoma. There is also operation plan suggesting the resection of the nerve plexus and soft tissue distributing along the artery vessels, and the nerve fiber bat around the pancreas. This operation is also named as skeletonization of the vasculature.

胰腺癌的主要治疗措施是根治性胰十二指肠切除术，也有的手术方案还建议切除胰腺周围沿动脉血管分布的神经丛和其他软组织，全部切除胰周区域的神经纤维板，即所谓的血管骨骼化。

Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy).

胆囊癌患者1例合并有中肝叶、胃窦、十二指肠、胰头及横结肠的广泛侵犯。经充分的术前准备，我们为其施行了根治性切除术，即胰十二指肠切除术+中肝叶切除术+横结肠切除术。

But we don't care about Battlegrounds.

但我们并不在乎沙场中的显露。

Ah! don't mention it, the butcher's shop is a horror.

啊！不用提了。提到肉，真是糟透了。