腹腔镜胰十二指肠切除术单中心62例体会与配合技巧

Surgical experience and cooperative technique of laparoscopic pancreaticoduodenectomy in single center with sixty-two cases

目的:总结腹腔镜胰十二指肠切除术(LPD)的相关手术体会及配合经验。方法:回顾分析2018年6月至2020年6月为62例患者行LPD的临床资料。结果:52例顺利完成LPD,10例中转开腹。手术时间260~540 min,平均(412.86±72.44)min;术中出血量100~1000 mL,平均(260.00±141.42)mL;术后平均住院(15.02±9.30)d;术后并发症:生化漏36例,无需特殊处理;B级胰瘘20例;C级胰瘘2例。术后病理学检查示:胰腺导管腺癌38例,十二指肠恶性肿瘤15例,胆管癌9例。结论:LPD手术难度较高,学习曲线较长,对术者及护理团队具有较高要求,术者必须具备丰富的开腹胰十二指肠切除的手术经验及腹腔镜技术,建议在熟练掌握开腹手术的基础上、团队配合成熟的中心开展LPD。

Objective:To summarize the surgical and cooperative experience related to laparoscopic pancreaticoduodenectomy(LPD).Methods:A retrospective analysis was performed on the clinical data of 62 patients who underwent LPD from Jun.2018 to Jun.2020.Results:All the 52 operations were performed successfully,10 cases were converted to open procedure.The operation time varied from 260 to 540 min,the mean was(412.86±72.44)min;The blood loss during surgery was 100-1000 mL with the mean of(260.00±141.42)mL.The average postoperative hospital stay was(15.02±9.30)d.Postoperative complications included 36 cases of biochemical leakage(no special treatment required),20 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula.Pathological result showed that there were 38 cases of pancreatic ductal adenocarcinoma,15 cases of duodenal cancer,and 9 cases of cholangiocarcinoma.Conclusions:LPD is an advanced surgical procedure which requires a relatively long learning curve.The operators as well as the nurses should use higher standard in their practice.Sufficient open surgery experience and laparoscopic technique need to be acquired before LPD can be safely performed.It is recommended that LPD can be performed by experienced professionals with effective teamwork.