动脉入路腹腔镜胰十二指肠切除19例报道

Laparoscopic Pancreaticoduodenectomy Through an Arterial Approach:A Report of 19 Cases

目的介绍动脉入路腹腔镜胰十二指肠切除术的方法，探讨腹腔镜胰十二指肠切除术的临床价值。方法回顾性分析2010年9月至2013年7月期间中山大学孙逸仙纪念医院肝胆胰外科施行的19例动脉入路腹腔镜胰十二指肠切除术患者的临床资料。结果19例均顺利完成腹腔镜下经动脉入路胰十二指肠切除术，无中转开腹病例；17例完成全腹腔镜下消化道重建，2例行开放消化道重建。手术时间5～10．5 h，平均6．3 h；术中出血170～430 mL，平均250 mL。所有病例术后病理学检查平均检出淋巴结13．7枚（9～21枚）。本组无围手术期死亡病例。总体并发症发生率为42．1％（8／19），其中胰瘘5例，胆汁漏1例，胃排空障碍和胃十二指肠动脉瘤各1例。术后平均住院时间10．7 d（7～19 d）。平均随访时间7．5个月（2～28个月），随访期间有6例患者因肿瘤复发或转移死亡。结论动脉入路腹腔镜胰十二指肠切除术简化了胰十二指肠切除及淋巴结清扫的过程，具有简便可行和淋巴结清扫彻底的特点。

Objective To introduce the method of laparoscopic pancreaticoduodenectomy through an arterial approach, and to evaluate the clinical value of this technique. Methods The clinical data of 19 patients with periampullary carcinoma, distal bile duct cancer, and early-stage pancreatic head carcinoma that underwent laparoscopic pancreaticoduodenectomy through an arterial approach in the Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital between September 2010 and July 2013 were retrospectively analyzed. The patients were followed-up until February 28, 2014. Results Laparoscopic pancreaticoduodenectomy were successfully performed in all 19 cases, there were no need to convert to open surgery. Open reconstruction was performed in 2 cases, and 17 cases underwent total laparoscopic reconstruction of the digestive tract. The duration of the operations ranged from 5-10.5 h(mean 6.3 h), and the intra-operative blood loss ranged from 170-430 mL(mean 250 mL). Post-surgical pathology detected a mean number of 13.7 lymph(9-21) nodes in all patients. No deaths occurred during the perioperative period. Complications were observed in 42.1%(8/19) of the subjects, including 5 cases with pancreatic fi stula, 1 case with bile leak, 1 case with gastric emptying disorder, and 1 case with a gastroduodenal artery aneurysm. The mean length of hospital stay was 10.7 d(7-19 d). The mean followed-up period was 7.5 months(2-28 months), there were 6 patients died of tumor metastasis or recurrence during the followed-up. Conclusion Laparoscopic pancreaticoduodenectomy through an arterial approach simplifi es pancreaticoduodenectomy and lymph node dissection procedures, and can completely remove lymph nodes.