腹腔镜胰十二指肠切除术66例初步经验总结  

Early experience of laparoscopic pancreaticoduodenectomy on 66 cases

作　　者：金巍巍[1] 徐晓武[2] 牟一平[2] 张人超[2] 鲁超[1] 张苗尊[1] 周育成[2] 王京瑞 

机构地区：[1]浙江大学医学院,杭州310029 [2]浙江省人民医院胃肠胰外科

出　　处：《中华外科杂志》2016年第2期84-88,共5页Chinese Journal of Surgery

基　　金：浙江省医药卫生平台计划资助项目（2015DTA010）

摘　　要：目的探讨腹腔镜胰十二指肠切除术（LPD）的安全性和可行性。方法收集邵逸夫医院2012年9月至2014年9月同一团队开展的66例LPD的临床资料，男性44例，女性22例，年龄（58．7±10．3）岁，体重指数（23．5±3．9）kg／m^2。术前有症状者45例；有上腹部手术史者6例，其中2例为腹腔镜胰腺手术后。结果66例患者中，接受腹腔镜标准胰十二指肠切除术63例，LPD联合右半肝切除术1例，腹腔镜胃癌根治术联合LPD1例，腹腔镜远端胰腺切除术后再次LPD1例。手术时间（367±49）min，出血量（193±126）ml。术后（1．8±1．0）d首次下床活动，（3．9±0．7）d肛门排气，（5．2±0．9）d首次进食半流质食物。术后总体并发症发生率为36．4％（24／66），其中B级及以上胰瘘发生率为4．5％（3／66），出血率为7．6％（5／66）。术后平均住院时间（18．9±12．1）d。术后病理检查结果显示，病灶大小（3．8±2．3）cm，获取淋巴结（20．3±10．9）个，恶性肿瘤47例。结论对于具有一定腹腔镜手术经验及技术的术者来说，LPD是安全可行的。Objective To evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy （LPD）. Methods Data of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of （58.7 ± 10. 3 ） years and mean body mass index of （23.5 ± 3.9）kg/m2. Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery. Results Of 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was （367 ±49） minutes. The mean blood loss was（ 193 ± 126） ml. The rate of overall postoperative complications was 36.4% （24/66）, with 4. 5% （3/66） of B or C pancreatic fistula and 7. 6% （5/66） of bleeding. The mean postoperative hospital stay was （ 18. 9 ± 12. 1 ） days. Mean tumor size was （3.8 ± 2. 3） cm, and the mean number of lymph nodes harvested was （20. 3 ± 10. 9）. Forty-severn patients were diagnosed as pancreatic adenocarcinoma（n = 18）, cholangiocarcinoma（ n = 7 ）, ampullary adenocarcinoma （ n = 21 ）, and gastric cancer （ n = 1 ）, respectively. Conclusion LPD is feasible and safe under the skilled hand.

关 键 词：腹腔镜手术 胰十二指肠切除术 胰腺肿瘤 

分 类 号：R657.5[医药卫生—外科学]