腹腔镜胰十二指肠切除术14例初步体会

Preliminary experience of laparoscopic pancreatoduodenectomy in 14 cases

目的探讨腹腔镜胰十二指肠切除术(LPD)的可行性及安全性。方法回顾性分析2017年2月至2019年1月在中山大学附属第三医院行LPD的14例患者临床资料。患者均签署知情同意书,符合医学伦理学要求。其中男6例,女8例;年龄49~72岁,中位年龄为63岁;术前影像学检查明确为壶腹部周围肿瘤,平均直径(2.7±0.7)cm。分析术中及术后并发症发生情况。结果12例接受标准完全LPD,1例LPD联合左半肝切除术,1例因胰腺萎缩未能找到胰管而中转开腹行胰胃吻合。手术时间(547±66)min,术中出血量(145±58)ml,术后住院时间(14±7)d。术后发生胰瘘2例,腹腔出血、胃肠道出血、肠梗阻各1例。术后病理检查结果显示,胆总管下段癌6例,壶腹部周围癌5例,胰腺钩突癌2例,胰腺钩突黏液性囊腺瘤1例。结论LPD具有创伤小、术后恢复快等优点。LPD学习曲线较长,在开展LPD初期宜选择病灶较小的壶腹部周围肿瘤病例。具备一定腹腔镜手术技术和经验的术者开展LPD是安全、可行的。

Objective To investigate the feasibility and safety of laparoscopic pancreatoduodenectomy(LPD).Methods Clinical data of 14 patients undergoing LPD in the Third Affiliated Hospital of Sun Yat-sen University from February 2017 to January 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,6 patients were male and 8 female,aged 49-72 years with a median age of 63 years.Peri-ampullar tumors were confirmed by preoperative imaging examination,with an average diameter of(2.7±0.7)cm.Intraoperative and postoperative complications were analyzed.Results 12 patients underwent standard total LPD,1 patient received LPD combined with left hemihepatectomy,and 1 patient was converted to laparotomy for pancreaticogastrostomy for the pancreatic duct could not be found due to atrophy.The operation time was(547±66)min.The intraoperative blood loss was(145±58)ml.The length of postoperative hospital stay was(14±7)d.Postoperative pancreatic fistula occurred in 2 cases,abdominal hemorrhage in 1,gastrointestinal hemorrhage in 1 and intestinal obstruction in 1,respectively.Postoperative pathological examination indicated that 6 cases were with lower common bile duct carcinoma,5 cases with peri-ampullary carcinoma,2 cases with pancreatic uncinate process carcinoma and 1 case with pancreatic uncinate process mucinous cystadenoma,respectively.Conclusions LPD has the advantages of small trauma and rapid recovery after operation.The learning curve of LPD is relatively long.In the early stage of performing LPD,it is suitable to select patients with small peri-ampullary tumors.It is safe and feasible to perform LPD by the operators with laparoscopic technique and experience.