Pancreatic body and tail resection

Pancreatic cancer occurs in the pancreas and tail, accounting for about 1/3. Because the early symptoms are not obvious, and the left upper abdominal mass and left lumbar pain have been advanced, surgical resection is difficult. In recent years, with the development of diagnostic techniques such as b-mode ultrasound and ct, the early detection of pancreatic body and tail tumors has increased, and the chance of pancreatic body and tail resection has also increased. Treatment of diseases: pancreatic cysts, chronic pancreatitis Indication 1. Early pancreatic body and tail cancer, without extensive invasion or metastasis. 2. Pancreatic islet cell tumor or cancer. 3. Chronic pancreatitis or associated body and tail cysts. Preoperative preparation 1. Correct the general condition, enter a high-calorie, high-protein diet, supplemented with bile salts and trypsin to help digestion and absorption. Repeated small blood transfusions before surgery can improve hemoglobin and blood pressure. 2. Treatment of jaundice, mainly to protect and improve liver and kidney function. Intravenous infusion of 10% glucose 1000ml daily for several days before surgery. It is very beneficial to use Chinese herbal medicines such as Yinchen, Atractylodes, Scorpion, Muxiang, Yujin and Artemisia annua. When there are conditions, the first ptcd or ercp drainage is the best yellowing measure. 3. Improve coagulation function, in addition to repeated fresh blood, should give enough calcium and vitamins K1, k3, c. Intramuscular injection of hemostatic agent 3 days before surgery. 4. Intrahepatic infection often occurs after biliary obstruction. Antibiotics, metronidazole, etc. should be routinely used before surgery to prevent infection. Surgical procedure 1. Incision: median incision in the upper abdomen, median incision in the left upper abdomen or l-shaped incision in the left abdomen. 2. Exploration: After the opening of the abdomen, first detect the presence or absence of metastases in the liver, hepatic hilum and mesenteric roots. Then the gastric ligament is incision, the pancreas is exposed, the surface of the pancreas is touched, and the peritoneum is cut from the lower edge of the pancreas and the tail if necessary, and the location, size, and extent and extent of tumor infiltration are determined to determine whether it can be removed. The spleen should be preserved as much as possible for benign tumors, and the spleen should be removed together for malignant tumors in order to remove the splenic lymph nodes and splenic lymph nodes from the upper edge of the pancreas. 3. Separation of the spleen: The assistant pulls the abdominal wall to the left side with a hook. The surgeon grasps the spleen with his left hand and pulls it to the right side, revealing the spleen and kidney ligaments and the spleen and ligament ligaments on the posterolateral side, and cutting the connection between these ligaments and the posterior abdominal wall with scissors. Continue to separate and cut the gastric spleen ligament along the direction of the stomach to the bottom of the stomach, and ligature the short vessels of the stomach one by one. 4. Separation of the pancreas and the tail: After completely dissipating the large curvature of the stomach and the spleen, the posterior peritoneum of the upper and lower edges of the pancreas and the tail is incised, and the adhesion of the opening and the posterior wall of the tail is separated from the side of the pancreas by the fingers. Direct to the neck of the pancreas. 5. Ligation, spleen movement, vein: Lift the spleen together with the body of the pancreas and the tail to turn to the right side, revealing the spleen and veins running on the posterior side of the pancreas. The pancreatic artery depends on the upper edge of the pancreas, and the splenic vein runs in the middle of the pancreas. As close as possible to the neck of the pancreas, double ligature the spleen, vein and cut. If the superior mesenteric vein or portal vein is just behind the junction of the pancreas and neck, the blood vessel should be separated from the pancreas to avoid accidental injury. 6. Excision of the pancreas, tail and spleen: a needle at the upper and lower edges of the pancreas at the proximal end of the predetermined tangential line should have a certain depth to ligature the pancreas and reduce bleeding. Then, at the distal end of the tangential line, a satinsky forceps is used to cut the tail of the pancreas and the spleen near the tangential line. 7. Treatment of pancreatic stump: The pancreatic duct was sutured through a 1-0 silk thread, and the pancreatic stump section was sutured with a 4-0 silk thread. After the peritoneal wound area was examined and the hemostasis was fully stopped, a double-chamber negative pressure drainage tube was placed at the stump of the pancreas and the spleen fossa, and the abdominal wall incision was sutured layer by layer.