Partial pancreatectomy

Partial pancreatic resection is a surgical treatment for partial necrosis, carcinogenesis and injury of the pancreas. Treating diseases: pancreatic cancer Indication 1. Pancreatic cancer or pancreatic tail cancer without distant metastasis. 2. It is not possible to remove benign tumors and cysts from the tail of the pancreas. 3. Break injury of the tail of the pancreas. 4. It is easy to remove the pancreatic body of the pancreas. 5. Gastric cancer invades the lymph nodes of the pancreas or pancreas and requires lymphatic clearing. 6. Pancreatic duct stones in the tail of the pancreas. 7. Chronic pancreatitis of the body tail that has been shown to be stenotic or blocked by the pancreatic pancreatic duct. Contraindications 1. The body of the pancreas has a distant metastasis. 2. Patients with severe heart, lung, liver, kidney disease and other systemic diseases cannot tolerate surgery. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Position: supine position, a cushion on the lower back. 2. Incision: Benign lesions When the pancreatic body is resected, the left lateral median incision is often used. When the pancreatic cancer is resected, an arc-shaped incision along the upper abdomen along the two rib edges should be used. If necessary, the incision from the lower part of the sword to the middle is added. 3. Exploration: If it is a benign lesion, the pancreas can be directly examined after a general examination of the abdominal organs to determine the location, size and relationship with the surrounding organs. If it is a malignant tumor, first check for ascites, intra-abdominal implantation and liver metastasis, and then continue to explore the hepatoduodenal ligament, peri-peri-aortic, para-aortic, mesenteric and transverse mesenteric roots with or without metastasis, Then cut the gastric ligament, pull the stomach up with a hook, and pull the transverse colon downwards by hand to reveal the tail and upper and lower edges of the pancreas. Check the nature and extent of the pancreatic lesion to determine the method of resection and the extent of resection. If necessary, perform a pancreatic biopsy. In the pancreatic biopsy, the pancreatic tissue can be taken by suction method and cutting method. The former is a cytological examination with a fine needle for the lesion, and the latter is cut at a suspicious lesion for a small piece of tissue. Pay attention to the following three points: 1 cutting depth should be sufficient; 2 avoiding the main pancreatic duct; 3 if a pathological result does not match the clinical diagnosis, it can be repeated multiple times and divided parts. 4. Free pancreas Because the spleen and veins pass through the parenchyma of the pancreas, there are many small blood vessels connected with the pancreas. It is difficult to separate. A slight accident can cause spleen and vein damage, bleeding or splenic vein embolism. Therefore, in most cases, the spleen is removed together, and there are two ways to remove the tail of the pancreas: one is free from left to right, that is, the spleen is freed first, then the tail of the pancreas is released, and the other is free from right to left. That is, the pancreatic neck is first cut, and then the tail of the pancreas and the spleen are freed. The selection principle of the two methods is generally considered to be biased toward the tail of the pancreas. It is better to use the right-to-left method. The position of the lesion is biased toward the pancreas. It should be from left to right. Sometimes for safety, the combination of left and right direction is used, especially for pancreatic cancer that has violated the celiac trunk or superior mesenteric artery. (1) Left to right resection method: 1 free spleen: cut the gastric ligament, stomach spleen ligament, spleen colon ligament, spleen and kidney ligament and spleen and sac ligament in turn, only the spleen pedicle is connected with the pancreas. 2 Free pancreatic body: Lift the spleen and turn to the right side, separate the loose tissue between the tail of the pancreas and the fat sac of the kidney, continue to free the pancreas to the right side, clamp and cut the peritoneum of the upper edge of the pancreas until the beginning of the splenic artery. Similarly, the lower edge of the pancreas is freed from the inferior mesenteric vein to the spleen vein or to the left side of the superior mesenteric artery. 3 cut off the spleen, vein: the free pancreatic body tail together with the spleen turned to the right side, the spleen artery was cut off at the scheduled pancreatic cutting line to the right close to the celiac artery, the broken end was firmly ligated with silk thread, and then the spleen was cut in the back of the pancreas The sheath on the vein separates the splenic vein, cuts and ligates it before it merges with the inferior mesenteric vein, and then continues to separate to the right, separating the superior mesenteric vein from the back of the pancreas. 4 cut the pancreas: cut the pancreas can be used in two ways: a. on both sides of the predetermined pancreatic cutting line with silk thread first through the suture, and then cut along the cutting line, pancreatic duct broken end and section bleeding point with a silk suture separately; b Use a non-invasive vascular clamp or a heart ear clamp to gently clamp the proximal end of the pancreas, but not too tight, in order to control the degree of bleeding in the section. When cutting the pancreas, pay attention to the position of the pancreatic duct, and then cut it with a mosquito-type vascular clamp and then cut it. Remove the tail of the pancreas and the spleen together, release the vascular clamp of the pancreatic end, suture the section of the bleeding point one by one, and double-ligature or suture the end of the pancreatic duct with a silk thread, and make a sputum about 1 cm away from the section. The suture is stitched, and the section is sutured with silk thread to suspend the front and rear edges of the cross section. 5 Placement drainage: After the above steps are completed, the surgical area is rinsed with saline to completely stop bleeding, paying special attention to hemostasis at the spleen bed, and a soft rubber tube is disposed at the lowest position in the spleen fossa, and the outer peritoneum is additionally poked out of the body.