全腹腔镜胰腺中段切除术的单中心初步经验(附4例报告)

Initial experience in total laparoscopic central pancreatectomy: a report of 4 cases

目的:探讨全腹腔镜胰腺中段切除术治疗胰腺颈体部良性或低度恶性肿瘤的可行性与实用性。方法 :对我院于2013年6月至2016年1月收治的4例胰腺颈体部良性或低度恶性肿瘤病人行全腹腔镜胰腺中段切除术。回顾分析手术方式、术后并发症及术后胰腺内、外分泌功能变化。结果:4例均成功实施全腹腔镜胰腺中段切除术和胰胃吻合,无中转开腹。手术时间180~300 min,术后住院时间10~69 d。肿瘤最大径1.0~2.5 cm,术后病理显示所有标本切缘阴性。术后并发症发生2列,其中A级胰漏1例,C级胰漏合并出血1例,该例经手术清创止血后痊愈。无围手术期死亡病例。术后随访时间15~40个月,无内、外分泌功能障碍及肿瘤复发。结论:全腹腔镜胰腺中段切除术用于治疗胰腺颈体部良性或低度恶性肿瘤,对于具有腹腔镜胰腺手术丰富经验的外科医师安全有效。

Objective To evaluate the feasibility and applicability of using total laparoscopic central pancreatectomy to treat benign or low-grade malignant tumor located in the neck or proximal body of pancreas. Methods From June 2013 to January 2016, four consecutive patients underwent total laparoscopic central pancreatectomy at our hospital. Data on surgical procedure, post-operative course, and follow-up were evaluated. Results All the patients successfully under- went total laparoscopic central pancreatectomy with pancreatogastrostomy. The operating time was 180-300 min. The dia- meter of tumor was 1.0-2.5 cm. The negative margin was all confirmed by postoperative pathological examination. The morbidity was present 1 case with grade A pancreatic fistula. The other case had grade C pancreatic fistula combined with bleeding cured operatively. The postoperative hospital stay was 10-69 days without mortality. No recurrence or any ex- ocrine or endocrine insufficiency was found after follow-up of 15-40 months. Conclusions Total laparoscopic central pan- createctomy is a safe and feasible technique for treating benign and low-grade malignant tumors in the neck or proximal body of the pancreas when performed by highly skilled pancreatic and laparoscopic surgeons.