腹腔镜胰十二指肠切除术单中心73例经验总结  

A single center experience with 73 cases of laparoscopic pancreaticoduodenectomy

作　　者：林先盛 黄强 杨骥 孙毅[1] 王程 LIN Xiansheng;HUANG Qiang;YANG Ji;SUN Yi;WANG Cheng(Division of Hepatopancreatobiliary Surgery,Department of General Surgery,the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital,Hepatobiliary and Pancreatic Laboratory of Anhui Province,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院/安徽省立医院普外胆胰外科/肝胆胰安徽省重点实验室,安徽合肥230001

出　　处：《中国普通外科杂志》2020年第3期284-290,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81272397);安徽省自然科学基金资助项目(1208085MH176);安徽省科技攻关资助项目(1804h08020277)。

摘　　要：背景与目的:胰十二指肠切除术(PD)操作复杂,是普通外科领域难度较大的手术之一。随着微创外科技术的发展,腹腔镜PD(LPD)已逐渐普及,并日趋成熟。本研究对笔者所在单位LPD的经验进行总结,以期进一步提高该手术的疗效与成功率。方法:回顾性分析2016年1月-2018年12月期间由中国科学技术大学附属第一医院胆胰外科同一团队开展的73例行LPD患者的围手术期临床资料及随访资料。结果:73例患者中,男31例,女42例;平均年龄(55.66±11.70)岁。平均手术时间(601.3±100.0)min,平均术中出血量(448.6±313.3)mL。术后胰瘘27例(36.9%),其中生化漏16例(21.9%),B级胰瘘6例(8.2%),C级胰瘘5例(6.8%);胃排空延迟发生46例(63.0%);术后出血6例(8.2%)。术后再手术者4例(5.4%),均为术后出血患者,围手术期死亡1例(1.4%)。术后病理学诊断为恶性肿瘤63例(86.3%),其中十二指肠乳头癌31例,胆总管下段癌13例,壶腹部恶性肿瘤14例,胰头癌5例;良性占位10例(13.7%),其中胰腺实性加乳头状瘤6例,胰头部黏液性囊腺瘤3例,胰腺神经内分泌瘤1例。随访时间4~35个月,平均11.5个月,期间未出现死亡病例。结论:LPD安全、可行,术后的并发症发生率在可接受的范围内,并可以达到根治性的手术要求。随着手术经验的不断积累,腹腔镜设备和器械不断改进,可广泛推广应用。Background and Aims:Pancreaticoduodenectomy(PD)is a complex surgical procedure,which is one of the most difficult procedures in general surgery.With the development of minimally invasive surgical methods,the laparoscopic PD(LPD)has been gradually gaining popularity,and become increasingly mature.This study was conducted to summarize the experience from the authors’hospital in performing LPD,so as to further improve the efficacy and success rates of this procedure.Methods:The perioperative clinical data and follow-up results of 73 patients undergoing LPD in the Department of General Surgery,the First Affiliated Hospital of USTC from January 2016 to December 2018 were retrospectively analyzed.Results:Of the 73 patients,31 cases were males and 42 cases were females,with an average age of(55.66±11.70)years.The average operative time was(601.3±100.0)min,the average intraoperative blood loss was(448.6±313.3)mL.Postoperative pancreatic fistula occurred in 27 patients(36.9%),including biochemical leakage in 16 cases(21.9%),grade B pancreatic fistula in 6 cases(8.2%)and grade C pancreatic fistula in 5 cases(6.8%);the delayed gastric emptying occurred in 46 patients(63.0%);the postoperative bleeding occurred in 6 patients(8.2%).Four patients(5.4%)underwent postoperative reoperation,and perioperative death occurred in one patient(1.4%).The postoperative pathology diagnosed malignant tumor in 63 patients(86.3%),of whom,31 cases were cancer of the duodenal papilla,13 cases were cancer of the lower portion of common bile duct,14 cases were malignant tumor of the ampulla of Vater,and 5 cases were cancer of the pancreatic head;benign occupying lesion in 10 patients(13.7%),of whom,6 cases were solid and papillary tumor of the pancreas,3 cases were mucinous cystadenoma of the pancreas and one case was pancreatic neuroendocrine tumor.Follow-up was performed for 4 to35 months,with an average of 11.5 month,and no death occurred during this time.Conclusion:LPD is safe and feasible,the incidence of postoperative complications is w

关 键 词：胰十二指肠切除术 腹腔镜 手术后并发症 

分 类 号：R657.5[医药卫生—外科学]