腹腔镜下根治性顺行模块化胰脾切除术在胰体尾恶性肿瘤切除中的应用(附6例报告)  

Laparoscopic radical antegrade modular pancreatosplenectomy for pancreatic body/tail cancer: with a report of 6 cases

作　　者：成伟[1] 滕雄 曾诗语 朱朝庚[1] 李国光[1] 黄生桃[1] 陈梅福[1] 尹新民[1] 彭创[1] 蒋波[1] CHENG Wei;TENG Xiong;ZENG Shi-yu(Department of Hepatobiliary Surgery,Hunan Provincial People s Hospital(The First-affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院,湖南师范大学附属第一医院胰腺疾病转化医学研究室,湖南长沙410005

出　　处：《腹腔镜外科杂志》2018年第9期689-693,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜下根治性顺行模块化胰脾切除术(laparoscopic radical antegrade modular pancreatosplenectomy,Lap-RAMPS)治疗胰体尾恶性肿瘤的适应证、可行性、安全性及临床疗效。方法:回顾分析2016年2月至2018年5月为6例患者行Lap-RAMPS的临床资料。结果:手术均顺利完成,无一例中转开腹;手术时间285(200～410) min,手术出血量142(50～300) m L,均获得R0切除;术后发生胰生化漏3例,胃排空障碍2例,不全性肠梗阻1例,均保守治疗痊愈。术后住院15.2(8～31) d,术后进食时间5(3～10) d,术后5.3(3～11) d排气,无再次手术病例。肿瘤最大径5.7(5～8) cm,病理示导管腺癌3例,其中高分化1例,低分化2例;高分化神经内分泌瘤、腺泡细胞癌、胰腺导管内乳头黏液性癌各1例。T_2期5例,T_3期1例; TNM分期(AJCC 7th)Ⅰ_B期4例、Ⅱ_A期1例、Ⅱ_B期1例。淋巴结清扫17.2(11～22)枚,淋巴结阳性1例(16.7%)。术后4例接受辅助化疗。6例患者均获得随访,1例于术后6个月发现肝内、腹腔网膜转移,继续静脉化疗; 1例于术后5个月发现术区复发,腹腔网膜及肝内多发转移,术后7个月死于肿瘤复发,余者均无瘤存活。结论:胰体尾恶性肿瘤患者行Lap-RAMPS安全、可行,可扩大手术适应证,短期效果满意,长期效果仍待进一步观察。Objective:To investigate the indications,feasibility,safety and efficacy of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS)in the treatment of malignant tumors of the body and tail of the pancreas.Methods:The clinical data of 6 patients who underwent Lap-RAMPS in Hunan People's Hospital from Feb.2016 to May 2018 were retrospectively analyzed.Results:No conversion to laparotomy occurred,and operative time was 285 min(200-410 min),blood loss was 142 mL(50-300 mL)and the R0 resection rate was 100%.6 cases of complications,including pancreatic biochemical leakage in 3 cases,gastric empty delay in 2 cases and incomplete intestinal obstruction in 1 case,were cured by conservative treatment;postoperative hospitalization time was 15.2 d(8-31 d),postoperative feeding time was 5 d(3-10 d),flatus time was 5.3 d(3-11 d),there was no reoperation cases.The maximum diameter of tumor was 5.7 cm(5-8 cm).3 cases were pancreatic ductal adenocarcinoma,of which one was highly differentiated and two were poor-differentiated.There were 1 case of highly differentiated neuroendocrine tumor,1 case of acinar cell carcinoma and 1 case of intraductal papillary mucinous carcinoma of the pancreas.There were 5 cases in T 2 stage and 1 case in T 3 stage.TNM stage(AJCC 7th)were 4 cases ofⅠB stage,1 case ofⅡA stage and 1 case ofⅡB stage.The number of lymph node dissection was 17.2(11-22),and the number of positive lymph node was 1(16.7%).4 cases received adjuvant chemotherapy.Six patients were followed up until now.One patient found intrahepatic and abdominal omentum metastasis 6 months after operation and received intravenous chemotherapy.One patient found recurrence in the operation area 5 months after operation and multiple metastasis in the peritoneal omentum and liver.He died of tumor recurrence at 7 months after operation.The rest were alive without tumor recurrence.Conclusions:Lap-RAMPS is safe and feasible for patients with malignant tumors of the body and tail of the pancreas.The operative indication of the di

关 键 词：胰体尾肿瘤 根治性顺行模块化胰脾切除术 腹腔镜检查 治疗结果 

分 类 号：R735.9[医药卫生—肿瘤]