胰腺外科手術(shù)術(shù)選擇胰腺外科手術(shù)術(shù)選擇1廖頭十二指女廖術(shù)PancreatoduodenectomyBeforesurgeryAftersurgeryStomachBileductallintestineRemainingpancreasStomachattachedtoDuodenumsmallIntestinSmallintestineOMByoFoundationforMedFcalEducationandRasearch.Allrightsreserved廖頭十二指女廖術(shù)2胰頭十二指女除術(shù)x定義BeforesurgeryAftersurgeryx胰頭十二指腸切除術(shù)BileductattachedBileductxWhipple手術(shù)x適應(yīng)證x1、壺腹癌emainingpancreasx2、下段膽總管癌attachedtosma3、十二指腸腫瘤Stomachattachedtosmallintestinex4、胰頭腫瘤Smallintestinex5、部分胰十二指腸良性腫瘤x6、慢性胰腺炎7、胰頭十二指腸受其它腫瘤侵犯胰頭十二指女除術(shù)3胰頭十二指女除術(shù)x歷史沿革x1898.AlessandroCodivilla,italianx1909,Waltherkausch,German,壺腹癌1912,describedbyWaltherKausch,Germanx1935,AllenWhipple,Americanx1937,BrunschwigGerman,胰腺癌1941,Whipple,一期手術(shù)x1941,Hunt,命名為Whipple手術(shù)x19605,并發(fā)癥率60%,死亡率25%Allenoldfatherx1981,vanheerden,是否該放棄該手術(shù)Whipple(1881x2019,美國胃腸病學(xué)會推薦PD治療陵腺癌1963)X2019,Imamura,RCT證明手術(shù)優(yōu)胰頭十二指女除術(shù)4外科高用解創(chuàng)外科高用解創(chuàng)5膽道解剖BiliarysystemHepaticDupaticDuct體paticDuct總囊底CommonBileDuct十二指腸大乳頭查度膽道解剖6展腺解剖PancreasandDuodenum(1)Cysticdireaticduct展腺解剖7頭十二指女除術(shù)女除圖BeforesurgeryAStomachBileductGallbladderremovedBodyandtailofpancreasPancreastumorStDuodenumSmallintestine頭十二指女除術(shù)女除圖8手術(shù)步驟檢違腫與門靜脈及限后出供興系Duodenum開二耗外舞胞手術(shù)步驟9手術(shù)步驟手術(shù)步驟10胰腺外科常用手術(shù)術(shù)式課件11胰腺外科常用手術(shù)術(shù)式課件12胰腺外科常用手術(shù)術(shù)式課件13胰腺外科常用手術(shù)術(shù)式課件14胰腺外科常用手術(shù)術(shù)式課件15胰腺外科常用手術(shù)術(shù)式課件16胰腺外科常用手術(shù)術(shù)式課件17胰腺外科常用手術(shù)術(shù)式課件18胰腺外科常用手術(shù)術(shù)式課件19胰腺外科常用手術(shù)術(shù)式課件20胰腺外科常用手術(shù)術(shù)式課件21胰腺外科常用手術(shù)術(shù)式課件22胰腺外科常用手術(shù)術(shù)式課件23胰腺外科常用手術(shù)術(shù)式課件24胰腺外科常用手術(shù)術(shù)式課件25胰腺外科常用手術(shù)術(shù)式課件26胰腺外科常用手術(shù)術(shù)式課件27胰腺外科常用手術(shù)術(shù)式課件28胰腺外科常用手術(shù)術(shù)式課件29胰腺外科常用手術(shù)術(shù)式課件30胰腺外科常用手術(shù)術(shù)式課件31胰腺外科常用手術(shù)術(shù)式課件32胰腺外科常用手術(shù)術(shù)式課件33胰腺外科常用手術(shù)術(shù)式課件34胰腺外科常用手術(shù)術(shù)式課件35胰腺外科常用手術(shù)術(shù)式課件36胰腺外科常用手術(shù)術(shù)式課件37胰腺外科常用手術(shù)術(shù)式課件38胰腺外科常用手術(shù)術(shù)式課件39胰腺外科常用手術(shù)術(shù)式課件40胰腺外科常用手術(shù)術(shù)式課件41胰腺外科常用手術(shù)術(shù)式課件42胰腺外科常用手術(shù)術(shù)式課件43胰腺外科常用手術(shù)術(shù)式課件44胰腺外科常用手術(shù)術(shù)式課件45胰腺外科常用手術(shù)術(shù)式課件46胰腺外科常用手術(shù)術(shù)式課件47胰腺外科常用手術(shù)術(shù)式課件48胰腺外科常用手術(shù)術(shù)式課件49胰腺外科常用手術(shù)術(shù)式課件50胰腺外科常用手術(shù)術(shù)式課件51胰腺外科常用手術(shù)術(shù)式課件52胰腺外科常用手術(shù)術(shù)式課件53胰腺外科常用手術(shù)術(shù)式課件54胰腺外科常用手術(shù)術(shù)式課件55胰腺外科常用手術(shù)術(shù)式課件56胰腺外科常用手術(shù)術(shù)式課件57胰腺外科常用手術(shù)術(shù)式課件58胰腺外科常用手術(shù)術(shù)式課件59胰腺外科常用手術(shù)術(shù)式課件60胰腺外科常用手術(shù)術(shù)式課件61胰腺外科常用手術(shù)術(shù)式課件62胰腺外科常用手術(shù)術(shù)式課件63胰腺外科常用手術(shù)術(shù)式課件64胰腺外科常用手術(shù)術(shù)式課件65胰腺外科常用手術(shù)術(shù)式課件66胰腺外科常用手術(shù)術(shù)式課件67胰腺外科常用手術(shù)術(shù)式課件68胰腺外科常用手術(shù)術(shù)式課件69胰腺外科常用手術(shù)術(shù)式課件70胰腺外科常用手術(shù)術(shù)式課件71胰腺外科常用手術(shù)術(shù)式課件72胰腺外科常用手術(shù)術(shù)式課件73胰腺外科常用手術(shù)術(shù)式課件74胰腺外科常用