腹腔镜在十二指肠腺癌治疗中的应用

Laparoscopy in the treatment of duodenal carcinoma

目的初步评估腹腔镜胰十二指肠切除术在十二指肠腺癌治疗中的应用价值。方法采用完全腹腔镜胰十二指肠切除术治疗十二指肠腺癌18例。肿瘤均位于十二指肠降段，其中16例位于十二指肠乳头区，2例位于十二指肠降部乳头外区。回顾分析手术情况和疗效。结果所有手术均完全在腹腔镜下完成。无中转病例。平均手术时间为435min，平均出血量为630ml，术后平均3．5d恢复肛门排气，术后平均住院22d。全组无死亡病例。总并发症发生率为44．4％，其中轻度胰漏2例，肺炎2例，应激性溃疡出血2例，切口愈合不良1例，1例腹腔出血。本组患者术后1、3、5年生存率分别为100％、80％、54．5％。结论腹腔镜胰十二指肠切除术治疗十二指肠恶性肿瘤是安全可行、有效的，可以达到根治手术要求，能遵循无瘤技术。

Objective The aims of the study were to explore the feasibility of laparoscopic pan- creaticoduodenectomy and to evaluate its value in the treatment of duodenal adenocarcinoma. Methods From November 2002 to December 2011 ,total laparoscopic pancreaticoduodenectomies were carried out in 18 patients with duodenal adenocarcinoma. All tumors located in the decending part of duodenum. Tumors of 16 patients were in the area of duodenal papilla,other two in extra-papilla area in the decending part of duodenum. Results All operations were completed laparoscopically. The mean operative time was 435 mi- nutes. The mean blood loss was 630ml. They passed flatus in average 3.5 days. The mean hospital stay was 22 days. They recovered well without death. The overall mobidity was 44.4%. Postoperative mobidity in- cluded mild pancreatic leak （ n = 2）, pneumonia （ n = 2 ）, stress ulcer bleeding （ n = 2 ）, poor incision heal- ing（n = 1 ）, and abdominal bleeding（ n = 1 ）. The one-, three- and five-year survivals were 100%, 80%, and 54.5% respectively. Conclusions Laparoscopic pancreaticoduodenectomy can be a safe and feasible procedure for duodenal adenocarcinoma. The technique can achieve radical resection effects and follow on- cological principles. However, it is still an risky operation with high mobidity and should be performed by highly skilled laparoscopic surgeons.