양성 질환에서의 췌십이지장 절제술

Abstract

Background/Arms: Recently, the operative technique and the knowledge of perioperative patient care were more advanced and the indication of pancreaticoduodenectomy was broadened. But in benign disease or unproven malignant lesions, it is still a difficult problem to select this surgical option. We reviewed our experiences of pancreaticoduodenectomy to evaluate its role for benign disease and make advice in the treatment of benign and suspected but unproven malignant perimapullary lesions.

Materials and methods: From March 1983 to June 1999, 401 patients were underwent pancreaticoduodencetomy in Department of Surgery, Yonsei University College of Medicine. Among them, 52 patients who were finally diagnosed as benign disease were selected and analyzed their clinical data.

Results: There were 35 males and 17 females and the mean age of patient was 47.3 years. Abdominal CT was the most commonly used diagnostic tool(82.7％) and ERCP, abdominal Us were also commonly used. Perioperative biopsies were performed 17 times in 15 patients but preoperative evaluation cannot rule out malignancy and the most common indication was suspicion of malignancy(67.3％). The most common final diagnosis was chronic pancreatitis, and benign tumors, benign biliary stricture in order of frequency. The mortality rate was 3.8％. The complications were occurred in 32.7％ of patients and delayed gastric emptying was most common but the majority of them were self-limited.

Conclusion: The serous morbidity and mortality of pancreaticoduodenectomy were low and the pancreaticoduodenectomy could be performed safely in benign disease. And also, it is very difficult to rule out malignancy in periampullary lesions before surgery, it is wise to perform pancreaticoduodenectomy in suspected but unproven malignant lesions.