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Objective To investigate the clinical efficacy of modified Takada procedure duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD) for the treatment of pancreatic head lesions.Methods 6 cases of DPPHR with the modified Takada procedure were compared with 6 cases of classical PD.The clinical data were analyzed,and the short-term prognosis was compared.Results The operation time was(281.7 ±42.6)min in DPPHR group,and(308.3 ±41.1)min in PD group (P ＜ 0.05).The intraoperative blood loss were (300 ± 187) ml in DPPHR group and (270 ± 66) ml in PD group (P ＞ 0.05).The postoperative recovery time to oral food-intake and postoperative hospital stay were (3.7 ± 1.6) days and (6.8 ± 1.7) days in DPPHR group and (9.0 ±4.3) days and(14.8 ±2.1)days in the PD group (P ＜ 0.05).The KPS scores at 3 months and 6 months after operation in DPPHR group (90.0 ± 6.2,96.7 ±5.1) were better than that of the PD group (78.0 ±7.5,90.0 ±6.3) (P ＜0.05).There was no significant difference between the two groups in the complication rate and recurrence rate in this period of time(P ＞ 0.05).Conclusion DPPHR with the modified Takada procedure is safe and effective for the treatment of pancreatic head lesions.
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Objective To explore the clinical application value of duodenum-preserving total pancreatic head resection by modified Takada procedure in the treatment of pancreatic head lesions.Methods Thc clinical data of 6 cases of modified Takada duodenum-preserving total pancreatic head resection in Zhangzhou Affilicated Hospital of Fujian Medical University and Zhangzhou Zhengxing Hospital from Sep 2013 to Sep 2014 was retrospectively analyzed.Results The mean operative time was (281.7 ± 42.6) minutes,the mean intraoperative blood loss was (300 ± 187) ml.The mean time to recovery to oral food-intake was (3.7 ± 1.6) days.Average length of hospital stay after operation was (9 ± 4.3)days.Of these cases,all preserved duodenal papilla and Vater ampulla and one-stage end-to-end anastomosis of the pancreatic duct in situ was done.Postoperative complications developed in 2 cases,one was pancreatic leakage and other one was bile leakage,all were cured conservatively.No perioperative deaths occurred.Postoperative pathology proved chronic pancreatitis in 3 cases and primary pancreatic tumors in another.3 Follow-up time ranged from 6 to 17 months,median was 13 months.There was no case of recurrence.Conclusions The modified Takada duodenum-preserving total pancreatic head resection removes pancreatic head where the lesion lies totally.One-stage end-to-end pancreatic duct reconstruction in situ is safe,ensuring fast and uneventful recovery.
RESUMO
Duodenum-and bile duct-preserving pancreatic head resection is rarely carried out in China due to its complexity.From September 2013 to May 2014,5 patients (1 with mass-forming pancreatitis of the head of the pancreas,2 with mucinous cystadenoma of the pancreatic duct combined with focal cancerous,2 with chronic pancreatitis and pancreatic duct stones) received duodenum-and bile duct-preserving pancreatic head resection at the Zhangzhou Zhengxing Hospital.The lesions of the 5 patients were resected by the Takada method and then the pancreatic duct was reconstructed in situ.One patient received T-tube drainage of the bile duct.The operation time was 210-330 minutes,and the mean volume of intraoperative blood loss was 300 mL (range,100-500 mL).The stones of 2 patients were antler-shaped,and the other 3 patients were with tumor.No patients died intraoperatively.One patient was complicated by pancreatic leakage and 1 by bile leakage after the operation,respectively,and they were cured by non-surgical treatment.Patients were followed up for 3-11 months,and no abnormal glucose metabolism,common bile duct stricture,chronic indigestion and tumor recurrence occurred.The Takada method is safe and effective for the treatment of mass-forming pancreatitis of the head of the pancreas,benign lesions of the head of the pancreas and low-grade malignant tumor of the head of the pancreas.