摘要
与主胰管毗邻的良性肿瘤,通常需要扩大切除范围,甚至实施胰腺-消化道吻合来恢复胰腺的外分泌功能,增加了术后严重并发症的风险.因此,如何维护主胰管的连续性和生理功能成为胰腺外科亟须解决的问题.为了减少手术对良性肿瘤患者的创伤,我们借鉴了桥梁合龙的原理,提出了胰管(修复)外科的概念,即对胰管进行整形或修复,恢复及维护其连续性和正常生理功能的一系列胰腺外科术式.在临床中,根据不同的肿瘤部位和切除范围,胰管(修复)外科可以分为主胰管修复术、胰腺端-端重建术、主胰管替代术和分支胰管型导管内乳头状黏液肿瘤(branch duct intraductal papillary mucinous neoplasm,BD-IPMN)局部切除等术式.为了探究胰腺端-端重建在生物力学上的可行性,我们建立了间断缝合术、连续缝合术和“荣式”手术的3种有限元模型,并进行拉伸模拟实验.“荣式”手术能够使拉伸时的应力分布更加均匀,拉伸受力更强,并且减少了缝线对胰腺组织的切割力,从而能够使得胰腺端-端对拢时耐受更大的拉力.胰管(修复)外科的提出明确了保护主胰管连续性和生理功能的重要性,避免扩大性切除手术和消化道重建,有助于促进患者术后恢复和提高远期生活质量,有望改变传统的胰腺良性疾病的手术治疗理念,通过创伤最小化和功能正常化的有机结合,使患者获得最佳的治疗结果.
Benign tumors adjacent to main pancreatic duct(MPD)usually require extended resection or even pancreato-digestive anastomosis to restore the exocrine function of the pancreas,which increases the risk of postoperative pancreatic leakage,bleeding,infection and other serious complications.Therefore,how to maintain the continuity and physiological function of MPD without damaging normal digestive tract anatomy has become an urgent problem for pancreatic surgery.In order to reduce surgical trauma to patients with benign tumor and obtain better treatment results and quality of life,the authors put forward the concept of pancreatic duct(repair)surgery,namely,a series of pancreatic surgical procedures for plastic surgery or repair of MPD to restore and maintain its continuity and normal physiological functions.Clinically,pancreatic duct(repair)surgery includes repair of MPD,end-end anastomosis of pancreas,replacement of MPD and BD-IPMN enucleation,etc.,according to different tumor sites and resection scopes.In order to explore the biomechanical feasibility of end-end anastomosis of pancreas,our team conducted tensile mechanical tests on normal fresh pancreas of pigs,established three finite element models based on interrupted suture,continuous suture and Rong’s surgery,and performed tensile simulation on the finite element suture model of pancreas.Studies have found that the Rong’s surgery can make the stress distribution during stretching more uniform,the tensile force is stronger,and reduce the cutting force of the suture on the pancreatic tissue,so that the pancreas can tolerate greater tension during end-end anastomosis.By exploring the minimum suture distance of Rong’s surgery,it was found that when the distance between the pinhole and the incision was greater than 4mm,the pancreatic tissue could better withstand the cutting force from the suture line.Pancreatic duct(repair)surgery clarified the importance of protecting the continuity and physiological function of MPD,advocated that functional pancreatic tissue should be preserved as far as possible,and extensive resection and digestive tract reconstruction should be avoided,which is helpful to promote postoperative recovery of patients and improve long-term quality of life,and is expected to change the traditional surgical treatment concept of benign pancreatic diseases.Through the organic combination of trauma minimization and functional normalization,patients can obtain the best treatment results.
作者
刘荣
刘渠
王子政
张修平
张卓超
常振宇
王斐
王超
张恭
Rong Liu;Qu Liu;Zizheng Wang;Xiuping Zhang;Zhuochao Zhang;Zhenyu Chang;Fei Wang;Chao Wang;Gong Zhang(Faculty of Hepatopancreatobiliary Surgery,the First Medical Center of Chinese People’s Liberation Army(PLA)General Hospital,Beijing 100853,China;Organ Transplantation Department,the Three Medical Center of Chinese People’s Liberation Army(PLA)General Hospital,Beijing 100039,China;Faculty of Hepatology,the Fifth Medical Center of Chinese People’s Liberation Army(PLA)General Hospital,Beijing 100039,China;Department of Mechanics,Harbin Institute of Technology,Harbin 150001,China)
出处
《科学通报》
EI
CAS
CSCD
北大核心
2023年第18期2376-2387,共12页
Chinese Science Bulletin
关键词
胰管损伤
胰腺良性肿瘤
胰管修复
胰腺中段切除
胰腺肿瘤剜除
pancreatic duct injury
benign pancreatic tumor
pancreatic duct repair
central pancreatectomy
pancreatic enucleation
作者简介
联系人:刘荣,E-mail:liurong301@126.com
