微创手术在胰腺囊性肿瘤治疗中的应用(附236例报告)

Minimal invasive surgery in treatment of pancreas cystic neoplasm:a report of 236 cases

目的:探讨微创手术在胰腺囊性肿瘤治疗中的可行性及安全性,并总结其适应证及优势。方法:回顾性分析我院自2005年9月至2015年7月期间接受微创手术236例胰腺囊性肿瘤病人的病例资料。根据手术方式分为机器人组(n=198)和腹腔镜组(n=38)。结果:机器人组包括:黏液性囊性肿瘤28例,导管内乳头状黏液性肿瘤46例,浆液性囊性肿瘤88例,实性假乳头状肿瘤36例,手术方式为胰十二指肠切除术61例,保留十二指肠的胰头切除术10例,胰体尾切除术85例,肿瘤剜除术12例,胰中段切除术30例。腹腔镜组包括:黏液性囊性肿瘤13例,导管内乳头状黏液性肿瘤3例,浆液性囊性肿瘤16例,实性假乳头状肿瘤6例,手术方式为胰十二指肠切除术2例,胰体尾切除术36例。3例中转开腹(1例机器人胰十二指肠切除手术,2例腹腔镜胰体尾切除手术),3例因术中操作困难行手助式腹腔镜手术,其余病人手术均在全腔镜下完成。术后并发腹腔出血3例,内疝1例,胰漏80例(A级33例,B级38例,C级9例),经处理后无围手术期死亡。随访至今,无复发和并发症发生。结论:微创手术治疗胰腺囊性肿瘤安全、可行,术后创伤小、恢复快。机器人手术在胰腺囊性肿瘤治疗中有一定优势,在手术方式上提供了更多的选择。

Objective To study and evaluate the feasibility,safety and indications of minimally invasive surgery in the treatment of pancreatic cystic neoplasm（PCN）.Methods The clinical data of 236 patients with PCN who received minimally invasive surgery at Ruijin Hospital from September 2005 to July 2015 were analyzed retrospectively.There were robotic group（n=198） and laparoscopic group（n=38）.Results The pathology in robotic group was mucinous cystic neoplasm（MCN）（n =28）,intraductal papillary mucinous neoplasms（IPMN）（n =46）,serous cystic neoplasm（SCN）（n =88） and solid pseudopapillary neoplasm（SPN）（n=36）.Sixty-one patients received pancreaticoduodenectomy,10 duodenum-preserving pancreatic head resection,85 distal pancreatectomy,12 enucleation and 30 central pancreatectomy.The pathology in laparo-scopic group was MCN（n=13）,IPMN（n=3）,SCN（n=16） and SPN（n=6）.Two patients received pancreaticoduodenectomy and 36 distal pancreatectomy.All surgery was successfully performed except 3 cases（1 robotic pancreaticoduodenectomy and 2 laparoscopic distal pancreatectomy） conversion to open surgery,and other 3 cases conversion to hand-assisted laparoscopic surgery.There were 3 cases with postoperative abdominonal bleeding,1 case with internal hernia and 80 cases with pancreatic fistula（33 Grade A,38 Grade B,9 Grade C）.There were no perioperative mortality and no complications and recurrence during the follow-up period.Conclusions The present case series was reported to demonstrate the minimally invasive surgery is safe and feasible in the treatment of PCN with less injury and faster recovery.