Middle-preserving pancreatectomy / 中华消化外科杂志

ABSTRACT

Objective:To investigate the clinical efficacy of middle-preserving pancreatectomy (MPP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of two patients who underwent MPP in Fujian Provincial Hospital from July 2019 to October 2019 were collected. Case 1 was a 52-year-old woman with multiple serous cystic neoplasms of the pancreatic head and tail. Case 2 was a 20-year-old man with chronic pancreatitis and multiple pancreatic duct stones. After comprehensive evaluation, two patients were performed laparoscopic pancreatic head tumor resection+ pancreatic tail resection+ splenectomy+ pancreaticojejunostomy and duodenum-preserving pancreatic head resection+ pancreatic tail resection+ lithotomy by longitudinal pancreatic duct incision+ side-to-side pancreaticojejunostomy, respectively. Observation indicators surgery, operation time, volume of intraoperative blood loss, blood transfusion, postoperative fasting blood glucose, postoperative complications, duration of postoperative hospital stay, postoperative pathological examination, and follow-up. Follow-up was performed using outpatient examination and telephone interview to detect new-onset diabetes mellitus, pancreatic enzyme replacement therapy and disease recurrence up to March 2020.Results:Two patients successfully underwent MPP. The operation time of case 1 and case 2 were 470 minutes and 400 minutes, the volume of intraoperative blood loss were 200 mL and 100 mL, respectively. No blood transfusion was performed in either patient. The postoperative fasting blood glucose fluctuated between 5.4 and 11.8 mmol/L in case 1, and fluctuated between 5.9 and 11.3 mmol/L in case 2. Case 1 developed abdominal infection after operation, and was discharged after anti-infective treatment. Case 2 had good recovery with no complication. No pancreatic fistula or perioperative death occurred in two patients. The duration of postoperative hospital stay were 12 days and 8 days of case 1 and case 2, respectively. The pathological examination of case 1 showed serous cystadenoma of the pancreatic head and pancreatic tail. The pathological examination of case 2 showed that slightly dilated pancreatic ducts of the pancreatic head and tail with multiple stones and chronic inflammatory cells infiltration around the pancreatic ducts. The length of pancreas preserved was 8.5 cm and 8.3 cm of case 1 and case 2 on postoperative computed tomography (CT) reexamination. Two patients were followed up for 5 months and 7 months, respectively. During the follow-up, both patients had no new-onset diabetes and they didn′t require pancreatic enzyme replacement therapy. Both patients underwent upper abdominal CT examination at postoperative 5 months, which showed good blood supply in middle pancreas and no signs of recurrence of cystadenoma or stones.Conclusions:MPP is a safe and feasible procedure for the treatment of multifocal pancreatic lesions. The procedure can eradicate the lesions and ensure good control of blood glucose in patients.