探讨完全3D腹腔镜胰十二指肠切除术治疗壶腹癌的可行性及3D视野下消化道重建的优势。

回顾性分析2016年6月至12月在汕头大学医学院第一附属医院行完全3D腹腔镜胰十二指肠切除术的2例患者临床资料。例1女，61岁，因"全身皮肤及巩膜黄染10 d"入院。TB 208 μmol/L，DB 107 μmol/L。MRCP及CT示壶腹部肿瘤。例2女，62岁，因"全身皮肤及巩膜黄染6 d"入院。TB 83 μmol/L，DB 45 μmol/L。MRCP示壶腹部肿瘤。术前诊断均为壶腹周围癌。患者均签署知情同意书，符合医学伦理学规定。采用3D腹腔镜显示系统行腹腔镜下胰十二指肠切除术和消化道重建。

例1手术时间495 min，术中出血量150 ml，未输血，术后病理学检查示十二指肠壶腹部腺癌。例2手术时间445 min，术中出血量120 ml，未输血，术后病理学检查示十二指肠壶腹部隆起型腺癌。2例患者术后恢复顺利，术后随访8～10个月，均未见肿瘤复发或转移征象。

完全3D腹腔镜胰十二指肠切除术是安全、可行的，3D腹腔镜系统可还原三维视觉及深度感知，符合人类生理的立体观看模式，可有效降低消化道重建的难度。

To explore the feasibility of complete 3D laparoscopic pancreaticoduodenectomy(LP) in treatment of ampullary carcinoma and the advantages of 3D digestive tract reconstruction.

Clinical data of 2 patients who underwent complete 3D laparoscopic pancreaticoduodenectomy in the First Affiliated Hospital of Shantou University Medical College between June and December 2016 were analyzed retrospectively. Case 1, female, 61 years old, was admitted for "yellow skin and sclera for 10 d", with TB 208 μmol/L and DB 107 μmol/L. MRCP and CT indicated ampullary tumor. Case 2, female, 62 years old, was admitted for "yellow skin and sclera for 6 d", with TB 83 μmol/L and DB 45 μmol/L. MRCP indicated a ampullary tumor. Both patients were diagnosed as periampullary carcinoma before operation. The informed consents of both patients were obtained and the local ethical committee approval was received. LP and digestive tract reconstruction were conducted by using 3D laparoscopic display system.

For case 1, the operation time was 495 min, the intraoperative blood loss was 150 ml, and no blood transfusion was conducted and postoperative pathological examination indicated duodenal periampullary adenocarcinoma. For case 2, the operation time was 445 min, the intraoperative blood loss was 120 ml, and no blood transfusion was conducted. Postoperative pathological examination indicated duodenal periampullary elevated adenocarcinoma. Both patients recovered well after operation and no tumor recurrence or metastasis was observed during 8-10 months follow-up.

It is safe and feasible to conduct complete 3D LP. 3D laparoscopic system can restore 3D vision and depth perception, which complies with the stereoscopic viewing mode of human physiology and effectively reduces the difficulty of digestive tract reconstruction.