“G”形手术路径的腹腔镜胰十二指肠切除术33例临床疗效分析

Laparoscopic pancreaticoduodenectomy via a ＂G ＂-shaped approach： experience of 33 cases

目的总结腹腔镜胰十二指肠切除术“G”形手术路径的临床经验。方法回顾性分析2015年4月至2018年3月山西医科大学第一医院33例采用“G”形手术路线腹腔镜胰十二指肠切除术患者的临床资料。结果33例患者均顺利完成手术，手术时间340～498min，术中出血量150～800ml，手术标本切除时间135～270min。术后患者未发生严重并发症，其中10例出现生化漏，3例出现B级胰漏，1例出现胆漏，6例出现不同程度的胃排空障碍。术后病理证实33例患者中17例为胭总管下段腺癌。11例为十二指肠乳头腺癌。5例为胰头部中低分化腺癌。结论腹腔镜胰十二指肠切除术的“G”形手术入路在缩短标本切除时间，减少术中出血，提高淋巴结清扫效率方面有价值．并可降低手术的难度。

Objective To investigate the feasibility and safety of ＂G＂-shaped surgical approach in laparoscopic pancreaticoduodeneetomy. Methods The clinical data of 33 patients who received ＂ G＂- shaped laparoscopic pancreatieoduodenectomy in the First Hospital of Shanxi Medical University from April 2015 to March 2018 were retrospectively analyzed. Results All patients underwent surgery successfully. The time required for surgery ranged from 340 to 498 min, the blood loss ranged from 150 to 800 ml, and the specimen resection time ranged from 135 to 270 min. There were 10 cases of biochemical leakage, 3 cases of B grade pancreatic fistula and 1 case of bile leak. Postoperative pathology confirmed lower bile duct adenocarcinoma in 17 cases, duodenal papillary adenocarcinoma in 11 cases and poorly differentiated adeuocarcinoma of the pancreatic head in 5 cases. Conclusions ＂ G＂-shaped approach as a simple, effective and safe way for LPD, is particularly helpful for inexperienced hands.