分支胰管型导管内乳头状黏液腺瘤外科手术新策略:原位切除联合分支胰管齐根结扎术

The new strategies for side branch intraductal papillary mucinous neoplasm of pancreas surgical treatment:robot-assisted in situ resection of the neoplasm combined with ligation from the root of the side pancreatic duct

目的介绍一种新的近端胰腺分支胰管型导管内乳头状黏液腺瘤(side branch pancreatic ductal intraductal papillary mucinous neoplasm,SB-IPMN)手术策略——原位切除联合分支胰管齐根结扎术。方法回顾性分析2021年3月解放军总医院完成的1例近端胰腺SB-IPMN手术相关资料,术中借助机器人精细分离囊性病变区域和正常胰腺,解剖出病变处分支胰管的根部,齐根结扎分支胰管后原位切除整个囊性病变区域。结果手术顺利,镜下操作时间80 min,术中出血量约20 ml,术后7 d带引流管出院。结论原位切除联合分支胰管原位结扎术是一种新的SB-IPMN手术策略,该手术保护脏器功能的同时,做到生理解剖的最大保护。新术式有望取代现行扩大切除和消化道重建的规范手术,成为金标准术式。

Objective To introduce a new surgical strategy for side branch pancreatic ductal intraductal papillary mucinous neoplasm(SB-IPMN)in the proximal pancreatic,robot-assisted in situ resection of the tumor combined with ligation from the root of the side pancreatic duct.Methods The clinical data of a proximal pancreatic SB-IPMN operation completed in PLA General Hospital in Mar.2021 were retrospectively analyzed,robot-assisted fine separation of cystic lesions from normal pancreas,dissecting the root of the branch pancreatic duct,robot-assisted in situ resection of the tumor combined with ligation from the root of the side pancreatic duct.Results The operation was completed successfully,the operation time was 80 minutes under the microscope,and the blood loss was about 20 ml,the patient was discharged 7 days after the operation.Intraductal papillary mucinous adenoma was considered pathologically.Conclusions In situ resection combined with side pancreatic duct in situ ligation is a new surgical strategy,which reveals the concept of protecting organs functional,meantime,more attention paid to physiological and anatomical integrity protection.This new surgical strategy is expected to replace the current standard procedures of extensive excision and digestive tract reconstruction,this procedure will become the standard operation for the SB-IPMN in the future.