机器人辅助胰十二指肠切除术在高龄患者的应用

Application of robotic-assisted pancreaticoduodenectomy in the elderly patients

目的探讨达芬奇机器人辅助胰十二指肠切除术(robotic pancreaticoduodenectomy,RPD)在高龄患者的安全性及临床效果。方法回顾性分析2016年12月至2020年5月于中山大学附属第一医院胆胰外科接受RPD、年龄≥70岁患者的临床资料,分析术后转归。结果共16例年龄≥70岁的患者接受RPD,其中男9例、女7例;年龄70~85岁,平均(73.6±4.2)岁。所有患者均顺利完成RPD,无中转开腹。病因包括6例壶腹癌、6例胰腺导管腺癌、1例胰腺神经内分泌肿瘤、1例胰管内乳头状黏液性肿瘤、1例十二指肠乳头癌、1例十二指肠乳头腺瘤伴高级别上皮内瘤变。中位手术时间413 min(IQR:366~522 min),中位术中出血量50 ml(IQR:50~62.5 ml),16例患者均获得R0切除。3例(18.8%)患者术后发生并发症,包括1例(6.2%)术后早期胰肠吻合口出血,通过再手术止血;3例(18.8%)B级胰瘘合并腹腔内感染;1例(6.2%)胃排空延迟。无围手术期死亡。中位术后住院时间13 d(IQR:12~18 d)。结论RPD对于高龄患者安全可靠,近期治疗效果满意。

Objective To evaluate the safety and efficacy of robotic-assisted pancreaticoduodenectomy in the elderly patients.Methods The clinicopathological data of 16 patients who were over 70 years old and underwent robotic-assisted pancreaticoduodenectomy between Dec.2016 and May 2020 at Department of Pancreatobiliary Surgery,the First Affiliated Hospital of Sun Yat-Sen University,were analyzed retrospectively.Results There were 9 males and 7 females,with the mean age of(73.6±4.2)years(from 70 to 85 years).Robotic-assisted pancreaticoduodenectomy was successfully completed in all 16 patients,with no conversion.In etiologies,there were 6 cases of ampullay carcinoma,6 cases of pancreatic ductal adenocarcinoma,1 case of pancreatic neuroendocrine tumor,1 case of intraductal papillary mucinous neoplasm,1 case of duodenal papillary carcinoma and 1 case of duodenal papillary adenoma with high-grade intraepithelial neoplasia.The median operative time was 413 min(IQR:366-522 min)and the median intraoperative blood loss was 50 ml(IQR:50-62.5 ml).Curative resection was achieved in all 16 patients.Postoperative complications occurred in 3 patients(18.8%),including pancreatojejunostomy bleeding in 1 patient(6.2%),which was successfully managed by reoperation;grade B postoperative pancreatic fistula with intra-abdominal infection in 3 patients(18.8%);and delay gastric emptying in 1(6.2%).There was no perioperative mortality.The median postoperative hospitalization duration was 13 d(IQR:12-18 d).Conclusions The robotic-assisted pancreaticoduodenectomy is safe and reliable procedure in the elderly patients,with good short-term outcome.