扶镜手在腹腔镜胰十二指肠切除术中的作用及配合流程  

Coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy

作　　者：吴浩然 程发辉 段小辉[1] 魏荣光 周舟 田朕安 张恒 张鸿渐 毛先海[1] Wu Haoran;Chen Fahui;Duan Xiaohui;Wei Rongguang;Zhou Zhou;Tian Zhenan;Zhang Heng;Zhang Hongjian;Mao Xianhai(Department of Hepatobiliary Surgery,Hunan Provincial People’s Hospital,Changsha,410005,China)

机构地区：[1]湖南省人民医院肝胆外科,长沙410005

出　　处：《中华肝胆外科杂志》2019年第8期606-610,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：湖南省教育厅科学研究重点项目(16A127);湖南省科技计划重点研发项目(2015sk2050)

摘　　要：目的探讨扶镜手在腹腔镜胰十二指肠切除术(LPD)中的作用及配合流程。方法回顾性分析2014年1月至2017年3月在湖南省人民医院肝胆外科行LPD的101例患者的围术期资料,总结扶镜手在术中的作用及关键术野显露的配合流程。结果101例均在3D腹腔镜下完成胰十二指肠切除术,无中转开腹手术,手术时间(326.0±55.6)min,切除时间(174.4±42.5)min;消化道重建时间(101.0±21.4)min;胰肠吻合时间(40.5±8.7)min;胃肠吻合时间(26.3±5.5)min;胆肠吻合时间(24.4±6.5)min;术中出血(175.6±41.1)ml。术后病理为胆总管下端癌27例(26.7%)、壶腹部癌23例(22.8%)、十二指肠乳头癌39例(38.6%)、胰腺导管腺癌12例(11.9%),肿瘤直径(2.3±1.3)cm,淋巴结清扫数目为(16.7±4.2)枚,阳性淋巴结为(1.3±1.1)枚。术后平均住院时间14.8(8~29)d;术后发生胰瘘23例,其中生化瘘17例(16.8%)、B级瘘5例(5.0%)、C级瘘1例(1.0%),胆汁漏2例(3.0%),术后出血7例(6.9%);胃排空延迟4例(4.0%);腹腔感染6例(5.9%);肺部感染3例(3.0%);肠梗阻2例(2.0%);3例(3.0%)患者行二次手术,住院30天死亡患者1例(1.0%)。结论扶镜手应把握LPD中的"一轴二面四区",在行大Kocher切口,处理钩突危险三角等关键部位时,清晰显露各重要血管及脏器,及时预警术者,保障手术安全性及流畅性。在吻合时,不断调整视野远近,清晰显露吻合区术野,帮助术者提高缝合精度及吻合质量。Objective To study the coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy(LPD).Methods A retrospective analysis was conducted on 101 patients who underwent LPD at the Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,from January 2014 to March 2017.The study aimed to study the coordination and function of a laparoscopic assistant.Results LPD was successfully completed in all the 101 patients.There was no conversion to open surgery.The operation time was(326.0±55.6)min,and the resection time was(174.4±42.5)min.The digestive tract reconstruction time was(101.0±21.4)min.The time of pancreaticojejunostomy was(40.5±8.7)min.The time of gastrointestinal anastomosis was:(26.3±5.5)min.The time of biliary anastomosis was(24.4±6.5)min.The intraoperative bleeding was(175.6±41.1)ml.Postoperative pathological data showed that 27 patients(26.7%)had distal common bile duct cancer,23 patients(22.8%)ampullary carcinoma,39 patients(38.6%)duodenal papillary carcinoma,and 12 patients(11.9%)pancreatic ductal adenocarcinoma.The tumor diameter was(2.3±1.3)cm,and the number of resected lymph nodes was(16.7±4.2).The number of positive lymph nodes was 1.3±1.1.The length of postoperative hospital stay was 14.8(8~29)d.Twenty-three patients developed postoperative pancreatic fistula,including 17 patients(16.8%)with a biochemical fistula,5 patients(5.0%)with a grade B pancreatic fistula,and 1 patient(1.0%)with a grade C pancreatic fistula.There were 2 patients(3.0%)with bile leakage,7 patients(6.9%)with intra-abdominal bleeding,4 patients(4.0%)with delayed gastric emptying,6 patients(5.9%)with abdominal infection,3 patients(3.0%)with pulmonary infection,2 patients(2.0%)with intestinal obstruction,3 patients(3.0%)required a repeated operation,and 1 patient(1.0%)with death in hospital within 30 days after surgery.Conclusions The laparoscopic assistant should have the perspective of"one axis,two sides and four regions"in LPD,and warn the operator to ensure the safety and fl

关 键 词：胰十二指肠切除术 腹腔镜 扶镜手 配合流程 

分 类 号：R73[医药卫生—肿瘤]