“逆时针切除法”在完全腹腔镜胰十二指肠切除术中应用的初步体会(附8例报道)  

Preliminary experience of “counter clockwise resection” in total laparoscopic pancreaticoduodenectomy

作　　者：徐进[1] 许维雪[1] 邢戬[1] 张伟明[1] 王海南[1] 

机构地区：[1]中国医科大学附属盛京医院胰腺外科,沈阳110004

出　　处：《中国普外基础与临床杂志》2017年第9期1090-1094,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨"逆时针切除法"在完全腹腔镜胰十二指肠切除术中的应用并总结其体会。方法回顾性分析2016年7月至2017年1月期间中国医科大学附属盛京医院胰腺中心收治的8例行完全腹腔镜胰十二指肠切除术患者的临床资料。结果 8例患者中男3例,女5例;年龄(64.13±15.01)岁。十二指肠癌1例,胆管中下段癌2例,胰头癌4例,胰头巨大实性假乳头状瘤1例。本组8例患者均顺利完成手术,手术时间为(527.50±69.44)min,术中出血量为(368.75±162.43)m L,标本切除时间为(241.25±38.71)min,术后住院时间为(18.67±4.00)d。根据国际胰腺外科研究小组标准,术后发生A级胰瘘3例,B级胰瘘1例;所有患者无围手术期死亡、无术后出血及无胃排空障碍发生,仅有1例患者出现腹腔感染,胰瘘和腹腔感染患者均经保守治疗治愈。所有患者处于正常随访中,现无任何异常情况。结论从本组有限的病例资料初步来看,"逆时针切除法"可能是在完全腹腔镜下一种简便、安全、有效且比较容易掌握的切除法,但这还需要更多的临床实践来验证。Objective To discuss application of＂counter clockwise resection＂ in total laparoscopic pan- creaticoduodenectomy （TLPD） and summarize it＇s preliminary experiences. Method The clinical data of consecutive 8 patients underwent TLPD in the Department of Pancreatic Surgery, Affiliated Shengjing Hospital of China Medical University from July 2016 to January 2017 were analyzed retrospectively. Results There were 3 males and 5 females in these 8 patients. The age was （64.13±15.01） years. The results of postoperative pathology included 1 duodenal cancer, 2 distal biliary tract cancers, 4 pancreatic head cancers, and 1 solid pseudopapillary tumor of pancreatic head. All the 8 patients were performed with TLPD successfully, and the time of the operation was （527.50±69.44） min, the resection time of the specimen was （241.25±38.71） min, and the blood loss was （368.75±162.43） mL, the postoperative hospitalization stay was （18.67±4.00） d. There were no postoperative bleeding, perioperative death, and delayed gastric emptying. Four patients suffered from the pancreatic fistula including 3 cases of grade A and 1 case of grade B pancreatic fistulas, and 1 case suffered from the intra-abdominal infection, who were cured after the conservative treatment. All the patients were following-up, and there was no abnormality. Conclusion Preliminary results of limited cases in this study show that ＂counter clockwise resection＂ might be a safe, effective, and easy method of TLPD, but further research is need to study.

关 键 词：胰十二指肠切除术 腹腔镜 逆时针切除法 

分 类 号：R656[医药卫生—外科学]