Kocher切口尾侧入路在腹腔镜胰十二指肠切除术中的应用价值

Application value of Kocher incision caudal approach in laparoscopic pancreatoduodenectomy

目的探讨Kocher切口尾侧入路在腹腔镜胰十二指肠切除术(LPD)中的应用价值。方法回顾性分析2017年10月至2020年6月在我院行Kocher切口尾侧入路LPD的20例患者的临床资料。结果20例患者中,平均手术时间(5.2±1.5)h,平均术中出血量(350.0±45.0)mL,平均术后住院时间(18.2±9.6)d。17例患者通过腹腔镜完成手术,3例患者因肠系膜上静脉或门静脉受侵辅助上腹正中小切口。术后,6例患者出现A级生化漏,3例患者出现B级胰漏,3例患者出现胃瘫。20例患者术后病理诊断均为恶性肿瘤,其中胰腺癌11例,胆总管末端癌7例,十二指肠乳头癌2例。随访2~30个月,患者均健康存活。结论经Kocher切口尾侧入路可充分利用腹腔镜的视角优势,为LPD提供一个更流畅的解剖平面入口,安全、有效。

Objective To investigate the application value of Kocher incision caudal approach in laparoscopic pancreatoduodenectomy(LPD).Methods The clinical data of 20 patients undergoing LPD through Kocher incision caudal approach in our hospital from October 2017 to June 2020 were retrospectively analyzed.Results In 20 patients,the average operation time was(5.2±1.5)h,the average intraoperative blood loss volume was(350.0±45.0)mL,and the average postoperative hospital stay was(18.2±9.6)d.Seventeen patients were operated by laparoscopy,and 3 patients were assisted by midmidline incision due to superior mesenteric vein or portal vein invasion.After operation,6 patients had grade A biochemical leakage,3 patients had grade B pancreatic leakage,and 3 patients had gastroparesis.All of the 20 patients were diagnosed as malignant tumor by postoperative pathology,including 11 cases of pancreatic cancer,7 cases of distal common bile duct cancer and 2 cases of duodenal papillary cancer.Followed up for 2 to 30 months,all the patients were alive and healthy.Conclusion Kocher incision caudal approach can make full use of the advantages of laparoscopy and provide a smoother anatomical plane entrance for LPD,which is safe and effective.