腹腔镜胰十二指肠切除术13例临床分析

Laparoscopic pancreaticoduodenectomy:clinical analysis of 13 cases

目的探讨腹腔镜胰十二指肠切除术(LPD)治疗壶腹周围癌的安全性和疗效。方法 回顾性分析2016年7月至2019年7月在赣南医学院第一附属医院行LPD的13例壶腹周围癌患者临床资料。其中男7例,女6例;年龄36~60岁,中位年龄57岁。患者均签署知情同意书,符合医学伦理学规定。观察患者围手术期情况。结果 13例患者中11例接受标准LPD,2例因腔镜下手术困难中转开腹。手术时间中位数为523(487~577)min,术中出血量320(180~430)ml,术后住院时间32(22~53) d,患者总治疗费用7.6(4.9~17.7)万元。术后6例患者出现并发症,其中胰瘘3例,胆漏3例,腹腔内出血3例,腹腔积液2例,合并两种并发症1例,合并3种并发症2例,均经保守治疗痊愈。术后病理学检查结果显示,胆总管下段癌4例,十二指肠乳头癌4例,壶腹部周围癌2例,胰头癌2例,胰腺钩突腺癌1 例。结论与传统开腹PD相比,行LPD治疗壶腹周围癌具有微创、手术切口恢复快等优势。LPD难度较大,对施术者技术要求高,应加强对术者的培训学习,以降低术后并发症发生率。

Objective To evaluate the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) in the treatment of periampullary carcinoma.Methods Clinical data of 13 patients with periampullary carcinoma who underwent LPD in the First Affiliated Hospital of Gannan Medical University from July 2016 to July 2019 were retrospectively analyzed.Among them,7 patients were male and 6 female,aged36-60 years with a median age of 57 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The perioperative conditions of all patients were observed.Results Among 13 patients,11 cases received standard LPD,and 2 patients were converted to open surgery for the difficulty of laparoscopic surgery.The median operation time was 523(487-577) min,intraoperative blood loss was 320(180-430) ml,the length of postoperative hospital stay was 32(22-53) d and the total medical expense was 76(49-177) thousand yuan.Postoperative complications occurred in 6 cases,including 3 cases of pancreatic fistula,3 cases of bile leakage,3 cases of intraperitoneal hemorrhage,2 cases of peritoneal effusion,1 case with 2 complications and 2 cases with 3 complications.The patients were all cured by conservative treatments.Postoperative pathological examination showed that 4 patients were diagnosed with the lower common bile duct carcinoma,4 cases of duodenal papillary carcinoma,2 cases of periampullary carcinoma,2 cases of pancreatic head carcinoma and 1 case of pancreatic uncinate process adenocarcinoma.Conclusions Compared with traditional open PD,LPD for periampullary carcinoma has the advantages of minimally invasive and quick recovery of incision.LPD is a procedure with high difficulty and high level techniques are required.Technical training for the surgeon should be increased to decrease the incidence of postoperative complications.