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中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 212 -216. doi: 10.3877/cma.j.issn.2095-3232.2019.03.008

所属专题: 文献

临床研究

腹腔镜胰十二指肠切除初步经验
陈焕伟1,(), 王峰杰1, 邓斐文1, 李杰原1, 胡健垣1   
  1. 1. 528000 佛山市第一人民医院肝脏胰腺外科
  • 收稿日期:2019-01-25 出版日期:2019-06-10
  • 通信作者: 陈焕伟
  • 基金资助:
    2016年高校和医院科研基础平台项目(2016AG100561)

Preliminary experience of laparoscopic pancreaticoduodenectomy

Huanwei Chen1,(), Fengjie Wang1, Feiwen Deng1, Jieyuan Li1, Jianyuan Hu1   

  1. 1. Department of Hepatobiliary Surgery, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2019-01-25 Published:2019-06-10
  • Corresponding author: Huanwei Chen
  • About author:
    Corresponding author: Chen Huanwei, Email:
引用本文:

陈焕伟, 王峰杰, 邓斐文, 李杰原, 胡健垣. 腹腔镜胰十二指肠切除初步经验[J]. 中华肝脏外科手术学电子杂志, 2019, 08(03): 212-216.

Huanwei Chen, Fengjie Wang, Feiwen Deng, Jieyuan Li, Jianyuan Hu. Preliminary experience of laparoscopic pancreaticoduodenectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(03): 212-216.

目的

探讨腹腔镜胰十二指肠切除术(LPD)的可行性和安全性。

方法

回顾性分析2015年12月至2018年8月佛山市第一人民医院收治的15例LPD患者临床资料。其中男8例,女7例;平均年龄(61±9)岁;患者均签署知情同意书,符合医学伦理学规定。采用"五孔法"行LPD。观察患者围手术期情况及术后复发情况。

结果

患者均顺利完成手术,行腹腔镜辅助胰十二指肠切除术(LAPD)5例,完全LPD 10例。LAPD手术时间(492±66)min,术中出血量中位数330(100~700)ml;完全LPD相应为(547±82)min,205(100~300)ml;均无输血。LAPD术后住院时间(18±4)d,完全LPD(12±2)d。术后发生胰瘘4例,均为B级胰瘘,无C级胰瘘;胃排空延迟1例;无术后出血及胆漏等并发症。随访时间10 (2~36)个月,随访期间未见肿瘤复发。

结论

LPD安全有效,开展LPD应循序渐进,可先从LAPD开始逐渐发展到完全LPD,术者应具备丰富的开放手术经验和娴熟的腹腔镜操作技能。

Objective

To investigate the feasibility and safety of laparoscopic pancreaticoduodenectomy (LPD).

Methods

Clinical data of 15 patients with LPD admitted to the First People's Hospital of Foshan from December 2015 to August 2018 were retrospectively analyzed. Among them, 8 patients were male and 7 female, aged (61±9) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. LPD via five-port approach was performed. The perioperative conditions and postoperative recurrence were observed.

Results

All patients completed the operation successfully. 5 cases underwent laparoscopy-assisted pancreaticoduodenectomy (LAPD) and 10 cases of complete LPD. The operation time of LAPD was (492±66) min, and the median of intraoperative blood loss was 330(100-700) ml, and those of complete LPD were (547±82) min and 205(100-300) ml accordingly. No blood transfusion was given in two groups. In LAPD group, the length of hospital stay was (18±4) d, and (12±2) d in complete LPD group. Postoperative pancreatic fistula occurred in 4 cases, all of which were grade B. No grade C pancreatic fistula was observed. Delayed gastric emptying was observed in 1 case. No postoperative complications, such as hemorrhage and bile leakage occured. The follow-up time was 10(2-36) months. No tumor recurrence was found during the follow-up period.

Conclusions

LPD is safe and efficacious. It should be gradually carried out from LAPD to complete LPD. The surgeons should be highly experienced in open surgery and be skilled in laparoscopic operation.

图1 腹腔镜手术五孔法Trocar孔布局
图2 腹腔镜胰十二指肠切除术中消化道重建操作图
[1]
Cameron JL,He J. Two thousand consecutive pancreaticoduodenectomies[J]. J Am Coll Surg, 2015, 220(4):530-536.
[2]
牟一平,金巍巍.腹腔镜胰十二指肠切除术的现状与展望[J].中华外科杂志,2013, 51(4):301-303.
[3]
Kuroki T,Kitasato A,Adachi T, et al. Learning curve for laparoscopic pancreaticoduodenectomy: a single surgeon's experience with consecutive patients[J]. Hepatogastroenterology, 2014, 61(131):838-841.
[4]
Gagner M,Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy[J]. Surg Endosc, 1994, 8(5):408-410.
[5]
Gagner M,Pomp A. Laparoscopic pancreatic resection: is it worthwhile?[J]. J Gastrointest Surg, 1997, 1(1):20-25.
[6]
Palanivelu C,Rajan PS,Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center[J]. J Hepatobiliary Pancreat Surg, 2009, 16(6):731-740.
[7]
Croome KP,Farnell MB,Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?[J]. Ann Surg, 2014, 260(4):633-638.
[8]
Liao CH,Wu YT,Liu YY, et al. Systemic review of the feasibility and advantage of minimally invasive pancreaticoduodenectomy[J]. World J Surg, 2016, 40(5):1218-1225.
[9]
卢榜裕,陆文奇,蔡小勇,等.腹腔镜胰十二指肠切除治疗十二指肠乳头癌一例报告[J].中国微创外科杂志,2003, 3(3):197-198.
[10]
金巍巍,徐晓武,牟一平,等.腹腔镜胰十二指肠切除术单中心233例临床经验总结[J].中华外科杂志,2017, 55(5):354-358.
[11]
洪德飞,刘亚辉,张宇华,等.腹腔镜胰十二指肠切除术80例疗效分析[J].中国实用外科杂志,2016, 36(8):885-888.
[12]
王小明,孙卫东,胡明华,等.右后下入路动脉先行的腹腔镜胰十二指肠切除术[J].中华胃肠外科杂志,2016, 19(1):71-74.
[13]
Gumbs AA,Rodriguez Rivera AM,Milone L, et al. Laparoscopic pancreatoduodenectomy: a review of 285 published cases[J]. Ann Surg Oncol, 2011, 18(5):1335-1341.
[14]
Sharpe SM,Talamonti MS,Wang CE, et al. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the national cancer data base[J]. J Am Coll Surg, 2015, 221(1):175-184.
[15]
Song KB,Kim SC,Hwang DW, et al. Matched case-control analysis comparing laoaroscopic and open pylorus-preserving pancreaticoduodenectomy in patients with periampullary tumors[J]. Ann Surg, 2015, 262(1):146-155.
[16]
金巍巍,张人超,牟一平,等.腹腔镜胰头十二指肠切除术手术流程优化[J/CD].中华肝脏外科手术学电子杂志,2014, 3(6):10-12.
[17]
Asbun HJ,Stauffer JA. Laparoscopic pancreaticoduodenectomies: a word of caution.Author reply[J]. J Am Coll Surg, 2013, 216(6):1218-1220.
[18]
张航,王敏,秦仁义.3D腹腔镜胰十二指肠切除术的临床疗效[J].中华消化外科杂志,2016, 15(9):907-912.
[19]
吴祥虎,朱峰,王敏,等.腹腔镜胰十二指肠切除术的安全性和有效性研究[J/CD].中华腔镜外科杂志(电子版),2015(1):8-11.
[20]
牟一平,金巍巍.腔镜手术在胰腺外科中的应用[J/CD].中华肝脏外科手术学电子杂志,2014, 3(4):203-205.
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