腹腔镜保留十二指肠胰头切除术9例临床分析

Clinical analysis of laparoscopic duodenum-preserving pancreatic head resection in 9 cases

目的总结分析腹腔镜保留十二指肠胰头切除术(laparoscopic duodenum-preserving pancreatic head resection,LDPPHR)的相关经验。方法回顾性分析福建省立医院肝胆胰外科自2017年7月至2020年1月施行的9例LDPPHR患者的临床资料。结果8例患者顺利完成手术,1例中转。手术时间255~473min,术中出血50~800ml。术后2例患者无并发症;2例B级胰瘘;1例胆瘘伴远端胆管狭窄;1例B级胰瘘、胆瘘、少量腹腔出血伴远端胆管狭窄;1例B级胰瘘伴胰背动脉出血;1例慢性腹泻;1例继发性糖尿病。术后住院时间11~39d。术后病理诊断为胰腺炎合并胰管结石2例,胰腺实性-假乳头状瘤3例,胰腺导管内乳头状黏液性肿瘤2例,胰腺浆液性囊性肿瘤1例,胰腺黏液性囊性肿瘤1例。结论LDPPHR适用于胰头肿块型慢性胰腺炎、胰头良性及交界性肿瘤的治疗,具有创伤小、术后恢复快等优势,适宜在较大的胰腺外科中心推广,但仍需关注围术期并发症的防治。

Objective To summarize the experience in laparoscopic duodenum-preserving pancreatic head resection(LDPPHR).Methods The clinical data of 9 patients who underwent LDPPHR in our hospital from July 2017 to January 2020 were analyzed retrospectively.Results Eight patients underwent total LDPPHR,and 1 case was converted to laparotomy.The operation time was 255-473 minutes.The estimated blood loss was 50-800ml.Two patients were discharged without complications.Two patients developed grade-B pancreatic fistula,and 1 patient developed biliary fistula and distal bile duct stenosis.One patient developed grade-B pancreatic fistula,biliary fistula,mild abdominal hemorrhage,and distal bile duct stenosis.One patient developed grade-B pancreatic fistula complicated with hemorrhage of dorsal pancreatic artery.One patient suffered from chronic diarrhea and another patient acquired secondary diabetes mellitus after surgery.The postoperative hospital stay was 11-39 days.Pathologic reports confirmed the diagnosis of pancreatitis comorbid with pancreatic ductal stones in 2 patients,solid pseudopapillary neoplasm in 3 patients,intraductal papillary mucinous neoplasm in 2 patients,serous cystic neoplasm in 1 patient,and mucinous cystic neoplasm in 1 patient.Conclusion LDPPHR can be applied in patients with chronic pancreatitis who developed an inflammatory mass in the pancreatic head,or benign and borderline tumor.This procedure has the advantages of minor invasion and better recovery after surgery.It can be widely conducted in large pancreatic centers,while great attention should be paid to perioperative complications.