腹腔镜胰十二指肠切除术单中心233例临床经验总结  

Laparoscopic pancreaticoduodenectomy： a report of 233 cases by a single teamLaparoscopic pancreaticoduodenectomy： a report of 233 cases by a single team

作　　者：金巍巍[1] 徐晓武[1] 牟一平[1] 周育成[1] 张人超[1] 严加费[2] 周家瑜[1] 黄超杰[1] 鲁超[1] 

机构地区：[1] 浙江省人民医院胃肠胰外科,杭州310014 [2] 浙江大学医院院附属邵逸夫医院普外科

出　　处：《中华外科杂志》2017年第5期354-358,共5页Chinese Journal of Surgery

基　　金：浙江省重点研发计划资助项目（2015C03G1360047）;浙江省医药卫生平台计划资助项目（2015DTA010）

摘　　要：目的 总结单中心大宗病例腹腔镜胰十二指肠切除术（LPD）的临床经验.方法 回顾性分析2012年9月至2016年10月同一团队开展的233例LPD患者的临床资料.男性145例,女性88例;年龄19～92岁,平均（60.3±13.0）岁;体重指数16.3～36.8 kg/m2,平均（22.8± 3.5） kg/m2.临床表现：腹痛97例,梗阻性黄疸84例,消化道出血10例,发热3例,Whipple三联征1例.有腹部手术史者54例.结果 233例患者中,平均手术时间（368.0±57.4） min,术中出血量（203.8±138.6）ml,术后总体并发症发生率为33.5％,B级和C级胰瘘发生率为6.9％,术后出血发生率为9.9％.术后二次手术率为5.6％.术后30 d内死亡2例（0.9％）.术后平均住院时间（18.1±11.2）d.肿瘤平均最大径（3.9±2.4）cm,平均淋巴结清扫数量（21.3±11.9）枚,R0切除率98.7％.其中恶性肿瘤163例,包括胰腺癌84例,胆管下段癌17例,壶腹癌55例,十二指肠降部腺癌5例,胃癌1例,胃和十二指肠双重癌1例.结论 在术者熟练掌握腹腔镜下缝合止血等操作的前提下,选择合适的患者并根据患者术中情况选择合适的路径可以增加LPD的手术安全性,缩短手术时间.Objective To summary the experience of 233 cases of laparoscopic pancreaticoduodenectomy （LPD） performed by a single surgical team.Methods Data of patients undergoing LPD from September 2012 to October 2016 were reviewed.There were 145 males and 88 females with the mean age of（60.3± 13.0）years old,ranging from 19 to 92 years old,and the mean body mass index of （22.8 ± 3.5） kg/m2,ranging from 16.3 to 36.8 kg/m2.There were 195 patients with clinical manifestation and 54 patients who had the history of abdominal surgery.Results LPD were performed on 233 patients by same surgical team consecutively.The mean operative time was （368.0± 57.4） minutes.Mean blood loss was（203.8± 138.6）ml.The postoperative morbidity rate was 33.5%,with 6.9% of grade B or C pancreatic fistula and 9.9% of bleeding.The reoperation rate was 5.6%.The mortality during 30 days after operation was 0.9%.Mean postoperative hospital stay was （18.1± 11.2）days.Mean tumor size was （3.9±2.4）cm,and the mean number of lymph nodes harvested was 21.3± 11.9.One hundred and sixty-three patients were diagnosed as malignant tumor,including pancreatic adenocarcinoma （n =84）,cholangiocarcinoma（n =17）,ampullary adenocarcinoma （n =55）,duodenal adenocarcinoma （n =5）,gastric cancer（n =1）and duel cancer （n =1） located in distal stomach and duodenum.Conclusion The key point to make laparoscopic pancreaticduodenectomy a routine safe procedure is to operate the procedure under skilled hands in selected patients via suitable surgical approaches.

关 键 词：胰十二指肠切除术 腹腔镜检查 胰腺肿瘤 短期结果 

分 类 号：R656[医药卫生—外科学]