外科病理学实践：诊断过程的初学者指南第10章胰
第10章 胰（Pancreas）Whipple手术(The Whipple Procedure)The Whipple procedure is, at minimum, a pancreaticoduodenectomy, which may or may not also include pylorus of the stomach and the gallbladder. In the pylorus-preserving Whipple procedure, the simplest version, you receive the segment of duodenum from just past the pylorus to about 20 cm beyond the ampulla of Vater. The head of the pancreas is nestled in the curve of the duodenum near the ampulla; the pancreas is shaped like a J, and the head is the base of the J, with the uncinate process as the hook. The distal common bile duct runs through the pancreas and enters the ampulla, where it is joined by the main pancreatic duct (Figure 10.1). Usually it is only the head of pancreas that comes out; if the tail is also involved, you may get the total pancreas and spleen.Whipple手术至少是胰十二指肠切除术，可能包括或不包括胃幽门和胆囊。在保留幽门的Whipple手术中，最简单的术式是从刚过幽门到Vater壶腹外约20厘米的十二指肠段。胰头位于壶腹附近的十二指肠弯曲处；胰腺呈J形，胰头为J形的基部，钩突为弯钩处。远端胆总管穿过胰腺进入壶腹，在壶腹与主胰管相连（图10.1）。通常只有胰头露在外面；如果胰尾也受累，你可能会得到整个胰腺和脾。
Figure 10.1. Diagram of specimen obtain during a Whipple procedure. The head of the pancreas comes out attached to a segment of duodenum. The main pancreatic duct is visible at the pancreatic neck margin (a surgical margin). The common bile duct enters the pancreas to join the pancreatic duct (also a surgical margin). The uncinate process is the tip of the pancreas, and its edge abuts major vessels (a soft tissue margin).图10.1.Whipple手术标本示意图。露在外面的胰头与一段十二指肠相连。主胰管在胰颈切缘（手术切缘）可见。胆总管（也是一个外科切缘）进入胰腺与胰管相连。钩突在胰腺的一端，其切缘邻接大血管（软组织切缘）。图中文字：proximal margin，近端切缘ampulla，壶腹distal margin，远端切缘duodenum，十二指肠pancreatic neck and duct，胰颈和胰管common bile duct，
胆总管uncinate，钩突inked edge，墨染切缘There are five principal margins that are usually sampled on frozen section (see Figure 10.1). The first is the pancreatic margin, or the pancreatic neck (where the J is transected). This is usually taken as a shave margin, sampling the entire cross section of pancreas, and cancer anywhere on the slide is a positive margin. There is no neck margin on a total pancreatectomy.
reactive的意思冰冻切片通常要取5个主要切缘（见图10.1）。第一个是胰腺切缘或胰颈切缘（J形被切断的地方）。这里通常削取切缘，取胰腺的整个横截面，切片上任何位置有癌都视为阳性切缘。全胰腺切除术没有胰颈切缘。The second margin is the common bile duct margin, which is a shave of the bile duct stump. This ensures that cancer is not tracking up the bile duct toward the liver.第二个切缘是胆总管切缘，这是胆管残端，也是幻灯片。这确保癌不会沿着胆管向肝转移。The third is the uncinate margin. This is the tip of the short end of the J, and it represents the place where the pancreas sits against the major vessels. For the uncinate, you should take one representative perpendicular margin, and the edge of the tissue is inked. Cancer on the slide is okay, as long as it does not touch ink. As this tissue abuts major vessels, the surgeon often cannot resect additional tissue anyway.第三个是钩
突切缘。这是J形短端的尖端，代表胰腺靠着大血管的位置。对于钩突，切取一个有代表性的垂直切缘，并且组织切缘已涂抹墨水。切片上有癌是可以的，只要它不接触墨水。由于该组织毗邻大血管，外科医生通常无法切除更多的其他组织。The fourth and fifth margins are the proximal and distal duodenal margins. It is rare for these sections to contain tumor.第四和第五个切缘是十二指肠近端和远端切缘。这些切片很少含有肿瘤。Most Whipple procedures are performed for a pancreatic mass seen radiologically. Although it is possible to get a cancer diagnosis by fine-needle aspiration, this is not always performed, and false-negative results are not uncommon. Therefore, often our first look at the tumor is during the Whipple procedure.大多数Whipple手术是针对放射学看到的胰腺肿块。虽然可以通过细针穿刺获得癌诊断，但并不总是这样，假阴性结果并不少见。因此，我们通常在Whipple手术标本第一次看到肿瘤。（译注：补充胰腺解剖示意图如下）

版权声明：本站内容均来自互联网，仅供演示用，请勿用于商业和其他非法用途。如果侵犯了您的权益请与我们联系QQ:729038198，我们将在24小时内删除。