The Clinical Application Of Duodenum-preserving Total Pancreatic Head Resection With The Modified Takada Procedure

Objective:To explore the clinical application value of duodenum-preserving total pancreatic head resection with the modified Takada procedure in the treatment of pancreatic head lesions.Methods:Between September 2013 and August 2014, we underwent 6 cases of duodenum-preserving total pancreatic head resection with the modified Takada procedure in fujian zhangzhou hospital affiliated to the fujian medical university and fujian zhengxing hospital. All cases preserved duodenal papilla and Vater ampulla and primary reconstruct the pancreatic duct in situ, 4 cases of them added Kocher incision, 4 cases of them completely preserved the anterior superior pancreaticoduodenal artery arch and the posterior superior pancreaticoduodenal artery arch. We summarized the clinical data, operative methods and complications of all these cases, to explore the clinical value of this operation in the treatment of pancreatic head lesions.Results:The pancreatic head of the 6 patients were resected by the modified Takada procedure and then the pancreatic duct was reconstructed in situ primarily.The operation time was range from 210 to 330 minutes,and the mean intraoperative blood loss was 300 ml(range from 100 to 600 ml). Recovery to oral food-intake in postoperative 3 ~ 7 days, hospital stay after operation range from 5 to 16 days, with average 9 days. There are 2 cases of postoperative complications. There were complicated by pancreatic leakage and leakage, respectively,and they were cured by non-surgical treatment.No duodenal ischemic necrosis, biliary tract obstruction and other complications, no perioperative deaths. Frozen pathological examination are used to exclude malignant tumor.There are 3 cases of chronic pancreatitis and 3 cases were pancreatic tumor.All the patients were followed up for 6~17months.No abnormal glucose metabolism, common bile duct stricture, chronic indigestion and tumorrecurrence. One cases of intraductal mucosal carcinoma were excluded reccurrence by MRI in 6months and 12 months postoperatively.Conclusion : The duodenum-preserving total pancreatic head resection with the modified Takada procedure could remove the lesion of the pancreatic head more clearly.It is safe and effective for the treatment of benign, borderline and low grade malignant tumor of the pancreatic head.The pancreatic duct was reconstructed in situ, which help retaining the continuity of stomach, duodenum, biliary tract and pancreatic duct and the function of Oddi sphincter. The postoperative recovery fast. It is the true sense of the preservation of anatomical and physiological function of duodenum and Vater ampulla.It is good procedure coinciding with physiology.