腹腔镜胰十二指肠切除术中转开腹的原因分析  

Reasons for conversion to laparotomy in laparoscopic pancreaticoduodenectomy

作　　者：王小明[1] 王冠男[1] 方小三[1] 孙卫东[1] 胡明华[1] 韩猛[1] 沈正超[1] 王徐[1] 

机构地区：[1]皖南医学院附属弋矶山医院肝胆外科,安徽芜湖241001

出　　处：《中华肝胆外科杂志》2017年第12期823-826,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省科技攻关项目（1501041156）

摘　　要：目的探讨腹腔镜胰十二指肠切除术（LPD）中转开腹的原因，以期提高腹腔镜胰十二指肠切除的安全性。方法皖南医学院附属弋矶山医院自2012年5月至2016年12月开展74例腹腔镜胰十二指肠切除术，其中7例中转。对7例患者的临床资料和手术情况进行回顾性分析，分析中转原因。结果中转患者中，男6例，女1例，年龄51-66岁；5例为胰头癌，1例为胰头慢性炎症，1例为十二指肠乳头癌。病灶最大径为2—6em，平均（3．8±1．4）cm。中转原因：4例为难以控制的出血，其中第一空肠静脉损伤2例，中转后缝扎止血；门静脉主干损伤1例，中转后行侧壁修补；胃结肠干出血导致根部的肠系膜上静脉损伤1例，中转后修补。另3例为病灶与肠系膜上静脉致密粘连，难以分离，中转后发现2例为肿瘤侵犯血管，联合血管切除重建；1例为炎症反应所致，经过仔细游离，将病灶与血管分开，完整切除肿瘤。7例患者术后并发症情况：胰漏1例，胃瘫1例，胆漏合并胃瘫1例，均保守治疗而愈。所有中转患者均顺利出院，无围手术期死亡。结论术中难以控制的出血及病灶侵犯门静脉系统是腹腔镜胰十二指肠切除术中转开腹的主要原因。Objective To study the reasons for conversion to laparotomy in laparoscopic pancreati- coduodenectomy （LPD）. Methods Of the 74 patients who underwent LPD in Yi Jishan Hospital, Wan Nan Medical College from May 2012 to Dec 2016, 7 patients were converted to laparotomy. The clinical and operative data of the 7 patients were reviewed. Results There were 6 males and 1 female. The age ranged was 51 to 66 years. The pathologies included tumor of pancreatic head in 5 patients, chronic inflammation of pancreas in 1 patient and duodenum papilla cancer in 1 patient. The reasons for conversion were： uncontrol- lable bleeding in 4 patients with superior mesenteric vein injury in 1 patient, portal vein injury in 1 patient and first jejunal vein injury in 2 patients, respectively. The bleeding was controlled successfully after lapa- rotomy in all the 4 patients. The conversion in the remaining 3 patients were due to difficulty in the operative procedures which resulted from severe adhesions between the tumor and the major vessels. There were 2 pa- tients who had invasion of the SMV by tumor. They underwent vascular resection after laparotomy. The re- maining patient had chronic inflammation and the lesion was resected successfully after careful dissection. Of the 7 patients, 1 patient developed pancreatic fistula, 1 patient developed delayed gastric emptying and 1 pa- tient developed both bile leakage and delayed gastric emptying. They were all treated conservatively. There was no peri-operative death in the study. Conclusion Uncontrollable bleeding and severe adhesions be- tween the lesion and maior vessels were the maior reasons in LPD for conversion to laparotomy.

关 键 词：腹腔镜 胰十二指肠切除术 出血 中转 开腹手术 

分 类 号：R735[医药卫生—肿瘤]