A new method for integrated radical resection of uncinate process of the pancreas: a report of 306 cases / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the methods and skills of integrated radical resection of uncinate process of the pancreas for patients with periampullary malignant tumor.</p><p><b>METHODS</b>From March 2005 to March 2010, 306 cases of radical pancreaticoduodenectomy (RPD) of periampullary malignant tumor had been continuously performed. By exchanging superior mesenteric artery and controlling blood stream of pancreatic uncinate process, the integrated radical resection of uncinate process for these patients had been successfully completed. Deal with restitution of alimentary tract by all using Child method. The method of simplify binding pancreaticojejunostomy was carried out to pancreatico-jejunal anastomosis. The cases included 169 male and 137 female with 37 - 79 years old, and the mean age was 58 years. Tumor types included 151 pancreatic head and neck tumors, 48 distal bile duct tumors, 55 ampullary tumors and 52 duodenal papilla tumors.</p><p><b>RESULTS</b>Among the 306 cases with RPD, operation time were 4 - 6 h and the blood loss were 200 - 600 ml with no intraoperative and postoperative bleeding of pancreatic uncinate process site. The incidence rates of postoperative bleeding and mortality were 3.3% and 0.9% respectively. The incidence rates of postoperative pancreatic fistula and biliary fistula incidence were 1.6% and 0.6% respectively. And patients with fistula had well recovered by expectant treatment of ultrasound-guided puncture and drainage. Follow-up to March 2010, there were no patients died from the recurrence of superior mesenteric vascular tumor.</p><p><b>CONCLUSIONS</b>By exchanging superior mesenteric artery and controlling blood stream of pancreatic uncinate process, the integrated radical resection of uncinate process for those patients who have periampullary malignant tumor can be successfully completed. It can reduce the operating bleeding, operating time and the miscut of superior mesenteric vein and(or) superior mesenteric artery, it can avoid postoperative pancreas necrosis off, infection and hemorrhage caused by the pancreas uncinate process residues, and it also theoretically reduces the chance of tumor cells spreading.</p>