完全腹腔镜下胰腺钩突部肿瘤切除术的临床疗效分析(附3例报告)

Clinical analysis complete laparoscopic resection of uncinate process tumor of pancreas(3 cases)

目的探讨完全腹腔镜下手术切除治疗胰腺钩突部肿瘤的临床疗效。方法回顾性分析深圳大学总医院2017年3月以来3例行完全腹腔镜下胰腺钩突部肿瘤切除术的患者的临床资料,总结围手术期处理方法及临床效果。结果3例患者均于完全腹腔镜下完成手术,术后1例有A级胰瘘,经应用胰酶抑制剂和肠外营养支持等治疗后痊愈;1例发生胃肠道功能障碍,经胃肠减压和肠外营养支持治疗后痊愈;1例神经内分泌肿瘤患者手术切除肿瘤后症状缓解,未再发作低血糖昏迷,空腹及餐后血糖水平明显升高,血清胰岛素水平均较术前明显降低,恢复正常胰岛素分泌波峰。无出血和腹腔感染等严重并发症发生;无围手术期死亡病例。3例患者术后均痊愈出院,随访13~47个月无异常。结论完全腹腔镜下胰腺钩突部肿瘤切除术安全可行,疗效好,可用于胰腺钩突部良性或神经内分泌肿瘤的切除。

Objective To explore the indications,methods and perioperative management of complete laparoscopic resection for uncinate process tumor of pancreas,then provide guidance for clinical work.Methods Three patients with uncinate process tumor of pancreas underwent complete laparoscopic resection since March 2017 were retrospectively analyzed,including perioperative management and the clinical effect.Result Three patients underwent completely laparoscopic surgery,1 patient with A-grade pancreatic fistula,after the application of pancreatic enzyme inhibitors,parenteral nutrition support and other treatment was cured;1 patient with gastrointestinal dysfunction,after gastrointestinal decompression,parenteral nutrition support treatment was cured.The symptoms of 1 patient with neuroendocrine tumor were relieved after tumor resection,and hypoglycemic coma did not occur again.Fasting and postprandial blood glucose levels were significantly increased,the serum insulin level decreased significantly and returned to normal peak of insulin secretion.No serious complications such as bleeding and abdominal infection occurred.There was no perioperative death.All the three patients recovered after surgery and discharged,and no abnormalities were observed during the follow-up of 13 to 47 months.Conclusion Complete laparoscopic resection of uncinate process tumor of pancreas is safe,feasible and effective,which can be used for the resection of benign or neuroendocrine tumor of uncinate process of pancreas.