再谈腹腔镜胰十二指肠切除术的现状与展望

The current status and future of laparoscopic pancreaticoduodenectomy

回顾近6年来我国腹腔镜胰十二指肠切除术(LPD)的主要进展:LPD的手术方法已经建立,包括切除的入路和流程、重建的方式及技巧,在技术上安全可行;LPD病例数快速增长,并在部分中心成为常规术式。LPD具有视野清、出血量少等优势,不仅利于患者快速康复,也有利于教学培训。然而,由于各中心LPD发展不平衡,较多中心仍存在术中和术后并发症多等问题,且关于恶性肿瘤患者能否远期获益尚有争议。因此,LPD今后的主要发展方向是建立监测体系,进行多中心随机对照试验研究或真实世界研究;建立常规术式时代新生代LPD术者的培训体系。

This review focused on the progress in laparoscopic pancreaticoduodenectomy(LPD)in the past six years.With the appropriate approaches under laparoscopy,including the resection and reconstruction,LPD has been proved to be safe and feasible.In some centers,LPD has been routine with rapid growth of numbers,it not only benefit the patients with fast recovery,but also benefit the trainees with similar sights as the primary surgeon and good videos of the procedures.However,LPD is still controversial as the more complications in some centers and inconclusive oncologic outcomes.Thus,in the further,a long-time outcome monitoring of LPD is essential.A registry of a prospectively maintained database may be a need for LPD to evaluate its outcomes by multicenter randomized control trials,and real world research may be of value.Structured LPD training programs are valuable for the new surgeons.