腹腔镜胰十二指肠切除术的临床应用：附22例报告

Experience in clinical application of laparoscopic pancreaticoduodenectomy:a report of 22 cases

目的:探讨全腹腔镜下胰十二指肠切除术(CLPD)的可行性、安全性及手术技巧。方法:回顾性分析2015年1月—2019年3月陕西省人民医院肝胆外科22例CLPD患者的临床资料,患者按常规五孔法行CLPD,胰肠吻合采用'胰管-空肠吻合+胰腺断端贯穿-空肠浆肌层闭环缝合法'。结果:22例患者均完成CLPD,无1例中转。平均手术时间为(655±65.66)min,术中平均出血量(364±177.76)m L,术中输血12例,平均输血(533±188.56)m L。本组患者术后总体并发症发生率为31.8%(7/22),其中A级胰瘘2例(9.0%),B级胰瘘1例(4.5%),胆瘘1例(4.5%),腹腔出血1例(4.5%),吻合口出血1例(4.5%),肺部感染1例(4.5%)。术后随访3~42个月,2例死于肿瘤复发,其余20例患者均存活,未见肿瘤复发或转移。结论:CLPD安全、可行,且具有创伤小、术后恢复快等特点,随着临床经验的不断积累,可进一步推广。

Objective:To evaluate the feasibility,safety and surgical skills of complete laparoscopic pancreaticoduodenectomy(CLPD).Methods:The clinical data of 22 patients undergoing CLPD in the Department of Hepatobiliary Surgery of Shanxi Provincial People’s Hospital from January 2015 to March 2019 were retrospectively analyzed.All patients underwent CLPD by using the conventional five-hole method,and pancreaticojejunostomy by using'pancreatic duct-jejunum anastomosis plus closed-loop suture running through the cut end of the pancreas to the seromuscular layer of the jejunum'.Results:CLPD was completed in all the 22 patients,without any open conversion.The average operative time was(655±65.66)min,average intraoperative blood loss was(364±177.76)m L,and 12 cases received an intraoperative blood transfusion,with an average volume of(533±188.56)m L.The incidence of overall postoperative complications was 31.8%(7/22),including grade A pancreatic fistula in 2 cases(9.0%),grade B pancreatic fistula in 1 case(4.5%),bile leakage in 1 case(4.5%),intraperitoneal hemorrhage,in 1 case(4.5%),anastomotic bleeding in 1 case(4.5%)and pulmonary infection in 1 case(4.5%),respectively.Postoperative follow-up was conducted for 3 42 months,2 patients died from tumor recurrence,and the other 20 patients were alive without recurrence or metastasis.Conclusion:CLPD is safe and feasible and also has the advantages of less trauma and quick postoperative recovery.This procedure can be further generalized with the constant accumulation of experience.