保留幽门的腹腔镜胰十二指肠切除术安全性及可行性分析  

Feasibility analysis and safety of laparoscopic pylorus-preserving pancreaticoduodenectomy

作　　者：张乙川[1] 蔡云强[2] 高攀[2] 李永彬[2] 彭兵[2] 

机构地区：[1]攀枝花学院附属医院肝胆胰外科,四川攀枝花617000 [2]四川大学华西医院胰腺外科,四川成都610041

出　　处：《局解手术学杂志》2017年第5期348-351,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨保留幽门的腹腔镜胰十二指肠切除术的安全性及可行性。方法回顾性分析2014年1月至2015年12月四川大学华西医院上锦分院肝胆胰微创中心施行的59例保留幽门的腹腔镜胰十二指肠切除术患者的临床资料。通过分析患者的术前一般资料、手术时间、术中出血量、中转开腹率、术后进食时间、术后住院时间及并发症发生情况等资料,探讨其安全性及可行性。结果 56例患者成功施行保留幽门的腹腔镜胰十二指肠切除术,幽门保留率达94.9%,3例患者因肿瘤累及肠系膜上静脉/门静脉中转开腹手术。59例患者手术时间为255~510 min,平均(384±145)min;术中出血量为50~800 mL,平均(148±28)mL;术后进食流质饮食的时间为1.0~4.0 d,平均(1.4±0.5)d;术后肛门排气时间为2.0~5.0 d,平均(3.2±1.1)d;术后平均住院时间为5.0~53.0 d,平均(10.3±2.6)d。16例患者术后发生并发症,发生率为27.1%;最常见的并发症为胰漏,共13例患者术后发生胰漏,其中A级胰漏12例,B级1例,无C级胰漏发生;6例术后出现胃排空障碍;1例出现胆汁漏。结论保留幽门的腹腔镜胰十二指肠切除术安全可行,可保留幽门且并未明显增加术后胃排空障碍发生率。Objective To investigate the safety and feasibility of laparoscopic pylorus-preserving pancreaticoduodenectomy.Methods The data of 59 patients with laparoscopic pancreaticoduodenectomy in Shangjin hospital of West China hospital of Sichuan University from January 2014 to December 2015 were analyzed retrospectively.The general data,operative time,estimated blood loss,conversion rate,time to liquid diet,postoperative hospital stay and complications were analyzed.Results The laparoscopic pylorus-preserving pancreaticoduodenectomy were successfully performed in 56 cases,the successful rate was 94.9%,the other 3 patients were converted to laparotomy for superior mesenteric vein/portal vein involvement.The operative time was 255～510 minutes,with mean operative time（384±145） minutes,the intraoperatve blood soss was 50～800 m L,with mean estimated blood loss（148±28） m L,the time to liquid diet was 1.0～4.0 days,with average time（3.2±1.1） days,the postoperative hospital stay was 5.0～53.0 days,with average time（10.3±2.6） days.After surgery,16 cases suffered from complication,the rate was 27.1%.The most common complication was pancreatic fistula which occurred in 13 cases including 12 cases of grade A and 1 case of grade pancreatic fistula.No grade C pancreatic fistula occurred in this series.Six patients suffered from delayed gastric emptying.One patient suffered from bile leakage.Conclusion Laparoscopic pylorus-preserving pancreaticoduodenectomy was safe and feasible.Pylorus-preserving does not increase the incidence of delayed gastric emptying.

关 键 词：腹腔镜 微创手术 保留幽门 胰十二指肠切除术 胰腺肿瘤 

分 类 号：R656[医药卫生—外科学]