The Clinical Study On Segmental Pancreatectomy

Objective:To summarize the experience on segmental pancreatectomy (SP) for pancreatic lesions.Methods:Retrospective analysis the clinic data of 15 cases who received segmental pancreatectomy during Nov.1997 to Jun.2009 in Sir Run Run Shaw Hospital, Zhejiang University. We collected the data including surgical site of lesions, surgical procedures, techniques, complications and the endocrine and exocrine function of the pancreas.Results:These 15 patients with a median age of 50 years old(rang:18-71 years old),5 were male and 10 were female. There were 3 patients of chronic pancreatitis and 12 patients of pancreatic space-occupying lesion. There were 2 cases companied with diabetes mellitus preoperatively After remove the spacemen, the proximal remnant of pancreas was closed by suture, and the distal remnant of pancreas were reconstructed with pancreaticojejunostomy in 12 cases and with pancreaticogastrostomy in the other 3 cases. The operation time was from 2.17hr to 6.83h, with an average of 5.10±2.32 hr. The blood loss was in the range of 200ml to 800ml, with an average of 427±224 ml. The median postoperative inpatient days was 14 days (rang:7-82 days). Pathologic diagnosis, there were 5 cases of pancreatic serous cystadenoma,3 cases of chronic pancreatitis,1 case of pancreatic micro-cystic adenoma,1 case of insulinoma, 1 case of pancreatic glucagonoma,1 case of pancreatic uncinate process of fat necrosis associated with xanthogranulomatous,1 case of pancreatic solid pseudopapillary tumor,1 case of well-differentiated adenocarcinoma,1 case of chronic pancreatitis accompanied adenocarcinoma. The margin of all cases was negative.5 patients suffered postoperative complications (5/15), including 1 patient with duodenal ulcer bleeding cured by reoperation; 2 patients developed intestinal obstruction for ankylenteron,1 reoperation; 1 patient developed pancreatic fistula,1 case with lung infection and mild chylous fistula, given symptomatic treatment were soon discharged. No patients died peri-operation. Median fasting plasma glucose 7 days post-operation compared with the preoperative (5.11mmol/l vs 5.39 mmol/1), statistical analysis showed no significant difference (t=0.752, p=0.31); three successive tests of the fat particles in stool were negative 1 week post-operative.14 of 15 patients were followed up for 3-141 months, median follow-up time was 39 months.2 cases of malignant patients,1 patient relapsed 2 months after operation,and biliary drainaged again for biliary obstruction, then lost to visit; one cases of recurrence 5 months died 11 months after opreation. All patients of benign tumor had a better quality of life, no impairment of endocrine and exocrine function.Conclusions:Segmental pancreatectomy was safe and feasible for the benign or borderline tumor in the neck of pancreas, and also helped confirm the diagnosis of the space-occupying lesion of preoperative unknown.Compared with traditional pancreatectomy,segmental pancreatectomy retained more normal pancreatic tissue, the influence of pancreatic endocrine and exocrine function was lighter after operation, and the spleen and duodenum were remained, thus maintaining the continuity of the normal digestive tract.Therefore, segmental pancreatectomy had an advantage preponderance for its micotrauma.