目的 探讨十二指肠球部远端溃疡的诊断和选择合适的手术治疗。方法 对我院25例十二指肠球部远端溃疡的临床资料进行了分析。结果 术前行上消化道X线钡餐检查8例，提示十二指肠球部溃疡4例，幽门梗阻2例； 纤维胃镜检查9例，发现十二指肠球部远端溃疡7例。术前确诊7例，误诊18例。20例曾行非手术治疗，但效果差，并出现溃疡并发症，如出血、穿孔、梗阻性黄疸、胆囊内瘘、幽门梗阻、急性胰腺炎等。本次手术治愈25例，1例术后9天并发输入、输出襻粘连性肠梗阻，经再次手术而愈。结论 纤维胃镜检查是诊断本病的主要方法，手术是该病的重要治疗措施。
ObjectiveTo summarize the application status and prospect of laparoscopic pancreaticoduodenectomy (LPD).MethodThe relevant literatures about studies of LPD at home and abroad were reviewed.ResultsLPD was a difficult operation, mainly suitable for pancreatic head and periampullary benign and malignant tumors. With the development of laparoscopic techniques in recent years, LPD combined the superior mesenteric vein and portal vein resection and reconstruction, or combined multi-visceral resection was feasible, but the survival benefit of LPD with arterial resection and reconstruction and extended lymph node dissection remained to be discussed. At present, there was no clear requirement on the way to reconstruct the pancreatic fluid outflow tract, but the pancreaticojejunostomy for digestive tract reconstruction was chose by the most surgeons. The most studies had confirmed that LPD was minimally invasive and had a short-term prognosis that was not inferior to that of open pancreaticoduodenectomy. However, the results of large sample analysis about long-term survival rate and oncology results were lacking, so it was difficult to judge the advantages and disadvantages of long-term prognosis of the two methods.ConclusionsLPD is a safe, feasible, reasonable, and effective surgical method. With improvement of laparoscopic technology, LPD is expected to become a standard operation method for treatment of pancreatic head cancer and periampullary carcinoma, and oncology benefits of LPD will be further confirmed in future by large-sample clinical randomized control trials and studies of long-term prognosis follow-up.
Objective To explore the hepatic artery variations encountered in laparoscopic pancreaticoduodenectomy (LPD) surgery and its significance. Methods The clinical datas of 26 patients who underwent LPD from January 2020 to January 2023 were retrospectively collected. Preoperative evaluation of hepatic artery variability and its types based on relevant clinical and imaging data, as well as targeted measures taken during surgery, and patients’ prognosis were analyzed. Results According to preoperative abdominal enhanced CT, arterial computer tomography angiography imaging and intraoperative skeletonization of the hepatoduodenal ligament, hepatic artery variation was found in 9 of 26 patients undergoing LPD. The left hepatic artery was substituted in 1 case, the right hepatic artery was substituted in 2 cases, 2 cases were the left accessory hepatic artery, and the common hepatic artery originated from the superior mesenteric artery in 3 cases. There was 1 case, right hepatic artery coming from the abdominal aorta, whose arterial variation was not included in the traditional typing. The variant hepatic artery from superior mesenteric artery was separated by posterior approach during operation, and the variant hepatic artery from left gastric artery was separated by anterior approach during operation. Nine patients with hepatic artery variation recovered well after operation, and no serious complications occurred. Conclusions Various hepatic artery variations during LPD need to be carefully evaluated before surgery. During surgery, it should be determined whether to retain the mutated blood vessel based on its diameter and changes in liver blood flow after occlusion, so that reasonable operation can be performed during the operation to avoid hepatic artery damage.
目的 探讨十二指肠良性肿瘤的诊断与治疗。方法 对1992~1998年间收治的10例患者的临床资料行回顾性总结分析。 结果术前经纤维十二指肠镜确诊7例 ，上消化道X线钡餐确诊3例。肿瘤位于十二指肠降部7例，球部3例。其中6例行手术治疗，4例因心肺脑等严重合并症行保守治疗。手术为十二指肠肿瘤局部切除连同周围肠壁组织部分切除。术后病理报告2例为平滑肌瘤，2例为布鲁氏纳氏腺瘤，2例为间质瘤。结论 十二指肠良性肿瘤可引发严重并发症，如出血、腹痛、肠梗阻、穿孔等，并约有15%的病例可发生恶变。一经诊断，应及早手术治疗，手术一般宜行局部切除。
目的 探讨创伤性十二指肠破裂的死亡原因及破裂口修补后易再破裂的原因。方法 对广西省北海市人民医院近8年来所作的12例十二指肠破裂手术进行回顾性分析。结果 全组病例中，治愈9例，死亡3例。死因： ①合并伤过重； ②单纯修补术后破裂口渗漏，继发腹腔感染； ③多处破裂被遗留，造成高位肠瘘。结论 对创伤性十二指肠破裂患者，①应首先处理重要合并伤； ②对十二指肠破裂应详细检查，防止遗留多发性破裂伤； ③十二指肠旷置减压术能有效降低十二指肠内压，减少胰液和胆汁分泌，提高破裂口的愈合率。
目的 介绍保留十二指肠乳头的胰十二指肠切除术。 方法 对2例重型十二指肠合并胰腺损伤患者行保留十二指肠乳头的胰十二指肠切除术。结果 无手术死亡,术后无胰瘘等严重并发症,均痊愈出院。结论 对胆总管完整、十二指肠乳头尚存的重型胰十二指肠损伤患者，急诊手术行保留十二指肠乳头的胰十二指肠切除是值得考虑和应用的安全手术方法。