缩短腹腔镜胰十二指肠切除术学习曲线的经验  

The Experience for Shortening The Learning Curve of The Laparoscopic Pancreaticoduodenectomy

作　　者：李敬东[1,2] 李勇[1,2,3] 冷政伟[1,2] 李强[1,2] 杨刚[1,2] 徐建[1,2] 闫在华[2,3] 唐小龙[2,3] 

机构地区：[1]川北医学院附属医院肝胆外科,四川南充637007 [2]川北医学院肝胆胰肠研究所,四川南充637007 [3]川北医学院临床医学系,四川南充637007

出　　处：《中国普外基础与临床杂志》2016年第4期398-402,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨缩短腹腔镜胰十二指肠切除术(LPD)的学习曲线。方法回顾性分析2015年5月至2015年11月期间川北医学院附属医院单治疗组开展的5例LPD患者的临床资料。结果 5例患者平均年龄58.8岁,4例为壶腹周围肿瘤,1例为胆总管下段肿瘤;平均手术时间588 min,平均出血量290 m L,平均进食时间5 d,平均住院时间25.25 d。5例中1例因心血管意外于术后第1天死亡,1例术后出血,经再次腹腔镜下缝合止血处理后痊愈,其余3例无并发症。结论成功开展LPD需要度过基本的学习曲线;LPD术中胰腺钩突部的切除与消化道的重建是关键;丰富的开腹胰十二指肠切除经验、手术流程的优化、娴熟的腔镜技巧、合适的病例、围手术期的精细管理和相对固定的配合团队是缩短LPD学习曲线的重要环节。Objective To investigate how to shorten the learning curve of the laparoscopic pancreaticoduodenectomy（LPD）. Methods Clinical data of 5 patients who underwent the LPD in our hospital from May 2015 to November 2015 were retrospectively analyzed. Results The mean age of 58.8 years old. There were four patients who were diagnosed with periampullary tumor, one patient was distal bile duct carcinoma. The median operative time was 588 min, the average blood loss was 290 m L, the time of feeding was 5 days, the mean hospital stay was 25 days. One case died of cardiovascular event on postoperative day 1. One patient had postoperative bleeding after LPD, who recovered smoothly after reoperation for hemostasis laparoscopiclly. Conclusions LPD needs basic learning curve. The key of this procedure are appropriate treatment of pancreatic head and digestive tract reconstruction. Rich operative experience of surgeon in pancreaticoduodenectomy, optimization of the operation process, skilled in laparoscopic procedures, appropriate cases, appropriate perioperative management, and steady surgical team are also important factor for the success of LPD and shorten learning curve.

关 键 词：腹腔镜胰十二指肠切除 学习曲线 

分 类 号：R657.5[医药卫生—外科学]