摘要
目的总结经肠系膜入路的胰头十二指肠切除术治疗十二指肠间质瘤的手术技巧。方法回顾性分析2014年6月哈尔滨医科大学附属第二医院收治1例十二指肠巨大间质瘤合并消化道出血、肝脏转移患者的临床资料。术前患者持续失血，CT检查示肝脏下方及右肾前方实质肿瘤，大小约为12．2cm×8．1cm，下腔静脉受肿瘤挤压狭窄，肝右叶实性肿瘤，结肠可疑受侵。经肠系膜入路行胰头十二指肠切除＋右半结肠切除＋肝转移瘤切除术。术后采用门诊和电话方式进行随访，随访时间截至2014年8月。结果手术时间为420min，术中出血量约为800mL，输RBC悬液2U，患者术后恢复顺利。术后病理学诊断：十二指肠间质瘤合并结肠、胰腺旁、肝脏、肾门旁转移瘤伴坏死。患者随访3个月生命质量良好。结论经肠系膜入路的根治性胰十二指肠切除术，手术初始阶段即开始处理肠系膜，以求最大限度地降低后续手术的风险和减少出血量。
Objective To summarize the surgical skills of the pancreaticoduodenectomy via mesenteric approach for the treatment of duodenal gastrointestinal stromal tumors （GISTs）. Methods The clinical data of 1 patient with huge duodenal GIST combined with gastrointestinal hemorrhage and liver metastasis who was admitted to the Second Affiliated Hospital of Harbin Medical University in June 2014 were retrospectively ana- lyzed. The patient had continuous bleeding before the operation. The results of computed tomography （CT） showed that there was a solid tumor below the liver and in front of the right kidney, with the size of 12.2 cm × 8.1 cm, inferior vena cava was squeezed by the tumor, a solid tumor was detected in the right lobe of liver, and the colon was suspiciously invaded by the tumor. The patient received pancreaticoduodenectomy, right hemicolectomy and right lobectomy of liver metastases. The patient was followed up by out patient examination and telephone interview up to August 2014. Results The operation time, volume of blood loss and volume of red blood cell （RBC） transfusion were 420 minutes, 800 mL and 2 U, respectively, with a full recovery of patients. The duodenal GIST with metastasis tumor and necrosis located at the colon, pancreatis, liver and renal hilum was confirmed by pathological diagnosis. The life quality of the patient was good by follow-up at postoperative month 3. Conclusion In the pancreaticoduodenectomy via mesenteric approach, surgeons perform vigorously the method of mesenteric approach at the first stage of operation, it could maximally reduce the risk of operation and the volume of blood loss.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第3期238-241,共4页
Chinese Journal of Digestive Surgery
基金
黑龙江省科技厅攻关项目（GCl2C304-1）
黑龙江省留学回国人员科技项目择优资助项目（2011297）
关键词
胃肠道间质瘤
消化道出血
肝脏转移
胰十二指肠切除术
肠系膜入路
AGastrointestinal stromal tumors
Gastrointestinal hemorrhage
Liver metastasis
Pancreaticoduodenectomy
Mesenteric approach
作者简介
通信作者：崔云甫，Email：yfeui777@hotmail．com
