胰十二指肠切除术

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。

The anatomical detect skill and mosquito clamp cross technique to peel off invasived vascular were adopted.58patients were undergone pancreatico duodenectomy,and the rate of resects was95%.The cases of near to the invasived vascular malignant tissue was41,and the cases of the lymph node metastasis was27,and the cases of around pancreatic nerve was30.1case died of bleeding,and the morbidity of complication was found in14cases,and no patients occurred fistula.

病例报告］回顾性分析 2003年9月―2006年6月间收治的61例壶腹部周围癌病人临床资料，采用解剖性探查及纹式钳勾划技术，给58例病人施行了一次性胰十二指肠切除术，手术切除率为95%，其中41例癌细胞侵入周边大血管，27例发生淋巴结转移，30例癌细胞侵入胰周神经丛。58例手术患者中围手术期死亡1例，出现并发症者为14例，未见并发胰漏及胆漏病例。

AIM: To prevent postoperative pancreatic leakage by applying modified Child pancreaticojejunostomy in pancraticoduodenectomy patients due to severe pancreaticoduodenal injury.

目的：采用改良Child胰肠吻合对胰肠吻合缝合技术进行改进，对严重的胰头、十二指肠损伤患者急诊行胰十二指肠切除术，预防胰漏发生。

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。

Key words］pancreatic tumor;duodenal tumor;pancreatoduodenectomy;vascular reconstruction;vascular prosthesis

关键词］胰头肿瘤；十二指肠肿瘤；胰十二指肠切除术；人工血管；血管重建

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。