保留功能的胰腺肿瘤微创手术初步经验

Preliminary experience of minimally invasive and function-preserving pancreatectomy

目的探讨腹腔镜、达芬奇等微创技术在保留功能的胰腺肿瘤手术中的应用价值。方法回顾性分析2020年9月至2021年5月中国科学院大学附属肿瘤医院开展的17例腹腔镜和1例达芬奇机器人保留功能的胰腺手术病例资料,统计手术时间、术中出血量、术后住院时间、术后胰瘘、腹腔出血、胃排空障碍发生率,术后新发糖尿病及需外分泌功能替代治疗情况。结果18例均成功完成手术,手术时间(214.7±85.3)min,术中出血量(205.3±114.6)mL,术后住院时间(14.2±8.7)d;术后总体胰瘘发生率为55.6%(10/18),腹腔出血发生率为5.6%(1/18),胃排空障碍发生率为11.1%(2/18);除1例保留十二指肠及脾脏的全胰切除手术外,其余病例均无新发糖尿病和术后需外分泌替代治疗的情况。结论腹腔镜保留功能的胰腺手术可以作为良性和低度恶性肿瘤的首选治疗方式,但是需要重视胰瘘这一并发症。在有条件的中心可以逐步开展达芬奇机器人保留功能的胰腺肿瘤手术。

Objective To investigate the value of minimally invasive technique applied in function-preserved pancreatectomy.Methods A totaol of 18 cases underwent minimally invasive function-preserved pancreatectomy between Sep.2020 and May 2021 were retrospectively analyzed,of which including 17 laparoscopic cases and 1 Davinci robotic case.The operation time,intraoperative blood loss,postoperative hospitalization time,and the incidences of postoperative pancreatic fistula,abdominal bleeding,delayed gastric emptying and endocrine and exocrine dysfunction were recorded.Results All surgery were completed successfully in 18 cases.The operation time was(214.7±85.3)min,intraoperative blood loss was(205.3±114.6)mL,postoperative hospitalization time was(14.2±8.7)d,and the overall incidence of pancreatic fistula rate was 55.6%(10/18),abdominal bleeding was 5.6%(1/18),postoperative delayed gastric emptying rate was 11.1%(2/18).Except for 1 case of total pancreatectomy,none case of new onset diabetes and severe exocrine dysfunction occurred.Conclusion Laparoscopic function-preserved pancreatectomy is considered as preferred surgical technique for the benign and low-grade malignant tumors,however,postoperative pancreatic fistula should be concerned.Davinci robotic surgery of function-preserved pancreatic surgery can be conduct in the experienced centers gradually.