腹腔镜根治性顺行模块化胰脾切除术治疗胰腺体尾部腺癌12例分析

Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic adenocarcinoma： analysis of 12 cases

目的探讨腹腔镜根治性顺行模块化胰脾切除术（Lap－RAMPS）治疗胰腺体尾部腺癌的安全性和可行性。方法回顾性分析2016年3月至2017年8月在浙江省人民医院胃肠胰外科接受Lap－RAMPS的12例胰腺体尾部腺癌患者的临床资料。男性7例，女性5例；年龄范围47～68岁，中位年龄60.5岁。所有患者术前均行全腹部增强CT、胰腺MRI、PET－CT以准确评估病灶位置、大小、毗邻关系，并排除远处转移。术后随访采用门诊和电话随访的方式。结果12例患者均顺利完成手术，无中转开腹或腹腔镜辅助手术。手术时间250 min（范围：180～445 min），术中出血量150 ml（范围：50～500 ml），术后2.0 d（范围：1～5 d）下床活动，术后3.0 d（范围：1～5 d）排气；首次进食流质时间3.5 d（范围：1～7 d），术后住院时间9 d（范围：4～18 d）。随访截至2017年10月30日，术后发生并发症8例，其中胃排空延迟1例，腹腔积液3例，术后出血1例。无围手术期死亡。淋巴结清扫数目为15.6枚，淋巴结阳性率为41.7%。所有患者均获得R0切除。中位随访时间为10个月。1例患者术后8个月发现肝脏转移，继续静脉化疗；1例患者术后14个月死于肿瘤复发和肝脏转移；其余10例患者仍无瘤存活。结论在经验丰富的中心并严格掌握手术指征的情况下，Lap－RAMPS可能使胰腺体尾部腺癌患者获得生存获益。

ObjectiveTo evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy（Lap-RAMPS） for left-sided pancreatic adenocarcinoma.MethodsClinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old（47-68 years old）. Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017.ResultsAll patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes（180-445 minutes）, and the blood loss was 150 ml（50-500 ml）. The medium first flatus time and diet resumption time were 3.0 days（1-5 days） and 3.5 days（1-7 days） respectively.The medium postoperative hospital stay was 9 days（4-18 days）. Morbidity occurred in 8 patients with gastric empty delay（n=1）, bleeding（n=1）, fluid collection（n=3）. There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis.ConclusionLap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.