腹腔镜胰腺癌手术研究进展及血管解剖要点

Research advances in laparoscopic surgery for pancreatic cancer and key points of vascular dissection

胰腺癌是恶性程度极高的消化系统肿瘤,手术对可切除性胰腺癌是首选。以腹腔镜为代表的微创胰腺手术开展已有近30年的历程,技术不断成熟。胰腺术区毗邻血管解剖复杂、手术难度大,对胰腺外科医师的挑战性较高。国际上对胰腺手术的安全性开展了一系列临床研究,得到了相对明确的结论。同时,应重视腹腔镜胰腺手术对毗邻血管的精细解剖及术中出血控制。本文通过回顾国内外腹腔镜胰腺手术的临床队列研究,在手术安全性、肿瘤学评价等多方面进行阐述和归纳。本文结合笔者的临床经验,阐述腹腔镜胰腺手术血管处理的经验和体会,希望与同道分享心得与见解。

Pancreatic cancer is a highly malignant tumor of the digestive system.Surgery is the ideal treatment for resectable pancreatic cancer.With advancements in surgical techniques,minimally invasive pancreatic surgery,such as laparoscopic surgery,has been carried out worldwide for nearly 30 years.However,the retroperitoneal location of the pancreas and the complexity of adjacent blood vessels make pancreatic cancer surgery extremely challenging.Clinical studies regarding the safety of laparoscopic pancreatic surgery have been conducted in various populations,with relatively clear conclusions.Precise anatomical dissection of main vessels within the pancreatic surgical field is essential to achieve minimal blood loss during surgery.We reviewed clinical studies of laparoscopic pancreatic surgery to summarize the safety and oncological outcomes of surgical treatments.We also introduce our first-hand experience in vessel management in laparoscopic pancreatic surgery.