腹腔镜胰十二指肠切除术45例体会

Experience of Laparoscopic Pancreaticoduodenectomy in Treatment of 45 Patients with Periampullary Diseases

目的探讨腹腔镜胰十二指肠切除术治疗壶腹部周围疾病的可行性和安全性,评估腹腔镜下不保留幽门的胰十二指肠切除术(LPD)和保留幽门的胰十二指肠切除术(LPPPD)的围手术期情况及并发症发生情况。方法回顾性分析本治疗组2010年1月至2014年3月期间行腹腔镜胰十二指肠切除术治疗壶腹部周围疾病的45例患者的临床资料。根据患者手术方式分为LPD组及LPPPD组。结果本组行腹腔镜胰十二指肠切除术的45例患者中有25例行LPD,有20例行LPPPD。1围手术期情况:手术时间为(472.95±33.47)min,术中出血量为(202.84±108.74)mL,术后ICU监护时间为(1.29±3.04)d,术后住院时间为(15.07±5.48)d。LPD组和LPPPD组患者的手术时间、术中出血量、术后住院时间、术后胃肠道减压时间及术后进食时间比较,差异均无统计学意义(P>0.05),但LPPPD组的术后ICU监护时间明显长于LPD组(P=0.028)。2术后并发症情况:有25例(55.56%)患者术后发生了并发症,其中胰瘘10例,胆汁漏1例,胃排空障碍6例,感染3例,吻合口出血2例,肠系膜血栓形成1例,术后腹腔积液1例,乳糜瘘1例。LPD组和LPPPD组总并发症发生率及具体的并发症发生率比较,差异均无统计学意义(P>0.05)。LPPPD组术后死亡1例。结论本组研究结果初步提示,腹腔镜胰十二指肠切除术治疗壶腹部周围疾病是可行的、安全的;另外LPPPD能够一定程度上避免幽门切除术后引起的消化液的返流等并发症,提高了患者术后的营养状态和生活质量。

Objective To investigate the feasibility and security of laparoscopic Whipple pancreaticoduodenec- tomy （LPD） or laparoscopic pylorus preserving pancreaticoduodenectomy （LPPPD） for the patients with periampullary diseases, estimate the ratio of postoperative complications between LPD and LPPPD. Methods Fourty-five patients who underwent the LPD or LPPPD from January 2010 to March 2014 were reviewed retrospectively. These patients were divided into LPD group and LPPPD group basing on the Whipple or polyrus preservation. Results Among these 45 patients, 25 patients were performed the LPD, the other 20 patients were performed the LPPPD. There were 25 （55.56%） complications after operation, including 10 cases of pancreatic fistula, 1 case of bile leakage, 6 cases of delayed gastric emptying, 3 cases of infection, 2 cases of stomach intestine stomatorrhagia, 1 case of mesenteric venous thrombosis, 1 case of ascites, 1 case of chylous fistula. The complication rate had no significant difference between two groups. One patient died after operation in the LPPPD group. Conclusion Laparoscopic pancreaticoduodenectomy is safe and feasible in the treatment of periampullary diseases, the LPPPD could partly prevent the occurrence of reflux of the digestive juice following the resection of pylorus and improve the quality of life.