九例腹腔镜下胰十二指肠切除术的临床疗效分析

Clinical analysis of nine patients with laparoscopic pancreaticoduodenectomy

目的 探讨腹腔镜胰十二指肠切除术（LPD）的安全性和可行性.方法 对2014年9月至2017年2月行LPD手术的9例临床资料进行回顾性分析.结果 9例患者中,接受完全腹腔镜下标准胰十二指肠切除术6例,2例行手助腹腔镜手术,1例中转开腹,手术时间（553.0±86.1）min,术中出血量（333.3±304.1）ml,术后住院时间（25.3±8.9）d,术后肠鸣音恢复时间为（3.5±1.0）d,术后并发症包括：胰漏4例,其中A级胰漏1例,B级胰漏3例,所有并发胰漏的患者都是通过非手术治疗治愈,淋巴漏1例,腹腔出血1例,胃排空障碍2例,胆漏1例,均是通过非手术治疗治愈,术后病理学检查结果示：十二指肠乳头腺癌5例,胰腺导管癌1例,胆总管中断分化癌2例,胰头潴留性囊肿1例,术后随访3~24个月,1例胰头导管癌患者存活17个月,1例胆总管中段癌患者术后12个月发现肝脏和腹膜后淋巴结转移,其余7例无并发症发生.结论 腹腔镜胰十二指肠切除术具有一定的微创优势,安全可行.

Objective To investigate the safety and feasibility of laparoscopic pancreaticoduodenectomy （LPD）. Methods Clinical data of 9 patients who underwent LPD operation from September 2014 to February 2017 in the first hospital of Shanxi Medical University were analyzed retrospectively. Results 9 patients attempted LPD, while one required conversation to open procedure. Two cases underwent hand assisted laparoscopic surgery .The average operative time was （553 ± 86.1） minutes, the average amount of bleeding was （333.3 ± 304.1） ml, and the average hospitalization time after operation was （25.3 ± 8.9） d. Postoperative bowel sound recovery time was （3.5 ± 1） d. Postoperative complications included pancreatic leakage in 4 cases （A grade pancreatic leakage in 1 cases, B grade in 3 case）, lymph leakage in 1 case, abdominal hemorrhage in 1 case , gastric emptying in 2 cases , and bile leakage in 1 case. All patients with postoperative complications were cured by non operative treatment. Postoperative pathological examination showed that 5 cases had duodenal papillary adenocarcinoma, 1 case had pancreatic ductal carcinoma, 2 cases had common bile duct disruption differentiation of carcinoma, and 1 case had pancreatic head retention cyst. Patients were followed up 3 to 24 months after operation. 1 case of pancreatic duct died 17 months after operation. One case of middle bile duct carcinoma 12 months after surgery had liver and retroperitoneal lymph node metastasis. The remaining 7 cases had no complications. Conclusions laparoscopic pancreaticoduodenectomy is minimally invasive, safe and feasible.