陈氏胰肠吻合在腹腔镜胰腺中段切除术中的应用

Application of Chen′s pancreatoenterostomy during laparoscopic central pancreatectomy

目的探讨陈氏胰肠吻合在腹腔镜胰腺中段切除术中的应用价值。方法回顾性分析湖南省人民医院肝胆外科2020年1月至2022年4月收治的11例接受腹腔镜陈氏胰肠吻合法的胰腺中段切除病人资料,统计分析病人的手术时间、术中出血量及输血量、肿瘤最大径、病理检查结果、术后住院时间、术后胰瘘发生率,并随访术后有无内外分泌功能不全的情况。结果手术时间为(383.2±82.8)min(225~485 min);术中出血量为(190.9±151.4)mL(50~400 mL);无术中及术后输血病例;肿瘤最大径为(3.43±0.96)cm(2.30~5.50 cm);术后住院时间为(17.4±7.8)d(8~34 d);术后胰瘘分级:生化漏8例,B级胰瘘3例,无C级胰瘘;术后病理检查结果统计:浆液性囊腺瘤2例,黏液性囊腺瘤2例,胰腺实性假乳头状瘤4例,胰腺导管内乳头状瘤1例,胰腺神经内分泌肿瘤1例(G1级),炎性肌纤维母细胞瘤1例。中位随访时间9个月(7~23个月),随访期间无肿瘤复发病例;无病例出现胰源性糖尿病或既往糖尿病加重,无病例出现消化不良、腹泻等外分泌功能不全症状。结论经过术前及术中的充分评估,在满足手术适应证的前提下,腹腔镜胰腺中段切除术应用陈氏胰肠吻合是安全可行的。

Objective To explore the application value of Chen′s pancreatoenterostomy during laparoscopic central pancreatectomy.Methods Retrospective analysis was conducted for clinical data of 11 patients undergoing mid-pancreatic resection via laparoscopic Chen′s pancreaticoenterostomy from January 2020 to April 2022.Operative duration,intraoperative blood loss,volume of blood transfusion,maximal tumor diameter,pathological examination results,postoperative hospital stay and postoperative pancreatic fistula incidence were recorded.Follow-ups were conducted for internal and external secretion insufficiency.Results Median operative duration was(383.2±82.8)(225-485)min and intraoperative blood loss(190.9±151.4)(50-400)mL.No blood transfusion was required.Maximal tumor diameter was(3.43±0.96)(2.30-5.50)cm and hospital stay(17.4±7.8)(8-34)days.Postoperative pancreatic fistula classifications were biochemical leakage(n=8),B leakage(n=3)and no C leakage.The results of postoperative pathological examination were serous cystic neoplasm(n=2),mucinous cystic neoplasm(n=2),solid pseudopapillary neoplasm(n=4),intraductal papillary mucinous neoplasm(n=1),pancreatic neuroendocrine neoplasm(G1 grade,n=1)and inflammatory myofibroblastoma(n=1).During a median follow-up period of 9(7-23)months,there was no occurrence of tumor recurrence,pancreatic diabetes,diabetic aggravation or exocrine insufficiency such as dyspepsia and diarrhea.Conclusion After thorough perioperative evaluations,Chen′s pancreatoenterostomy is both safe and feasible during laparoscopic central pancreatectomy under the premise of fulfilling surgical indications.