开放、腹腔镜及机器人胰十二指肠切除术评价与合理选择  

The application of open,laparoscopic and robotic pancreaticoduodenectomy

作　　者：张人超[1] 金巍巍[2] 牟一平[1] 

机构地区：[1]浙江省人民医院胃肠胰外科浙江省胃肠病学重点实验室,浙江杭州310014 [2]浙江大学医学院,浙江杭州310029

出　　处：《中国实用外科杂志》2016年第8期854-857,共4页Chinese Journal of Practical Surgery

基　　金：浙江省医学重点学科基金(No.CX-11-21);浙江省医药卫生平台计划(No.2015DTA010)

摘　　要：开放胰十二指肠切除术(OPD)仍然是治疗胰头部及壶腹部周围病变的标准术式,其术后病死率已经明显降低,但并发症发生率仍很高,其中包括切口感染等切口相关并发症。腹腔镜和机器人胰十二指肠切除术(LPD和RPD)视野清晰、出血少,具有明显的微创优势。经过严格训练,并选择合适的病例,LPD和RPD均安全可行,可获得与OPD相近的肿瘤治疗近期和远期效果。LPD目前已可成为常规术式。机器人手术系统设备昂贵,缺乏力反馈,技术要求高,但操作更精细,缝合较腹腔镜手术更有优势,更适合用于胰管、胆管直径细小的病例。腹腔镜手术切除标本后再使用机器人手术系统进行消化道重建的杂交手术有一定现实意义。建立由同时掌握开放、腹腔镜及机器人手术技术的外科医生为主导,影像科、消化内科、肿瘤内科和病理科等医生共同参与的多学科综合治疗协作组(MDT)模式,是合理选择开放、腹腔镜和机器人胰十二指肠切除术的关键。Open pancreaticoduodenectomy （0PD） is the standard and only curative treatment for pancreatic head and periampullary lesions. It is a safe procedure, but still have high morbidity rate, most of which are incisional complications. Laparoscopic or robotic minimally invasive pancreaticoduodenectomy have many advantages, including high-definition, lower estimated blood loss and fast recover, and the equivalent short-term and long-term oncological outcome. Laparoscopic pancreaticoduodenectomy （LPD） could be routinely practiced. Robotic Pancreaticoduodenectomy （RPD） is expensive, but have some advantages over laparoscopic surgery including more meticulous, suture easy and better, so it is more suitable for the patient with small size of pancreatic duct or bile duct. Hybrid PD （laparoscopic resection/robotic reconstruction） could promote the quality of operation. The application of multidisciplinary team （MDT） which was made up of surgeon experienced in open, laparoscopic and robotic technique, radiologist, medical oncologist, pathologist, gastroenterologist, is the key point to select the most appropriate procedure.

关 键 词：胰十二指肠切除术 机器人手术系统 腹腔镜 胰腺癌 

分 类 号：R6[医药卫生—外科学]