No-touch技术在胰头癌腹腔镜胰十二指肠切除术中的初步效果  

Initial clinical results of laparoscopic pancreaticoduodenectomy using the No-touch isolation technique for pancreatic head carcinoma

作　　者：谭志健[1] 沈展涛[1] 刘一峰 陈桂豪 钟小生[1] Tan Zhijian;Shen Zhantao;Liu Yifeng;Chen Guihao;Zhong Xiaosheng(Pancreas Center of Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院胰腺中心,广州510120

出　　处：《中华肝胆外科杂志》2020年第8期569-572,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省中医院院内专项面上项目(YN2018ML01)。

摘　　要：目的探讨No-touch技术在胰头癌腹腔镜胰十二指肠切除术中的初步临床效果。方法回顾性分析2019年4月至2020年4月广东省中医院胰腺中心所行腹腔镜胰十二指肠切除术的11例胰头癌患者,其中男性5例,女性6例,年龄(63.6±12.2)岁。所有患者术前评估,无动脉侵犯或远处转移,均为可切除病例。所有患者均应用No-touch技术,即先不进行Kocher游离,不翻转、不牵拉胰头十二指肠区域,通过优先钩突解旋,完全离断入胰和出胰血管、神经、淋巴管,隔绝肿瘤,最后才移动胰头十二指肠区域,进行整块切除,并采用Child法行消化道重建。评估患者手术时间、术中出血量、术后并发症、术后病理并对患者进行随访。结果所有患者均完成手术,无中转开腹。11例患者手术时间(422.2±102.2)min,出血量(102.7±65.4)ml。术后发生胰瘘2例,生化瘘1例,B级瘘1例,无C级瘘,无胆瘘,胃排空延迟1例,无术后腹腔出血,无围术期死亡病例。术后病理提示合并淋巴结转移6例,淋巴结阳性率(4.8±4.4)%,均获得R0切除。随访获得11例患者术后生存资料,1例于术后1个月发现肝内转移,术后9个月死亡;1例术后2个月出现肝脏转移;余患者现均无瘤存活。结论腹腔镜胰十二指肠切除术应用No-touch隔离切除技术实现了肿瘤的整块切除,可安全有效应用于胰头癌患者。Objective To study the preliminary clinical results of the No-touch technique in laparoscopic pancreaticoduodenectomy for pancreatic head cancer.Methods A retrospective analysis was consulted on 11 patients who underwent laparoscopic pancreaticoduodenectomy for pancreatic head cancer at the Pancreas Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from April 2019 to April 2020.There were 5 males and 6 females,with a Mean±SD age of(63.6±12.2)years.Preoperative evaluation showed all patients were diagnosed to have resectable pancreatic head carcinoma with no local invasion into adjacent arteries and veins,and without metastasis.The surgical strategy consisted of no initial Kocher manoeuvre with no flipping or pulling of the pancreaticoduodenal area.Through unwinding of the pancreatic uncinate process,the pancreatic blood vessels,nerves and lymphatic vessels were completely detached to isolate the tumor.Finally,the pancreaticoduodenal area was totally resected and the digestive tract was reconstructed using the Child’s method.The operation time,intraoperative blood loss,postoperative complications,postoperative pathology and follow-up data of the patients were evaluated.Results All patients completed the laparoscopic operation without any need for conversion to laparotomy.The operation time of the 11 patients was(422.2±102.2)min,and the bleeding volume was(102.7±65.4)ml.There were 2 patients who developed pancreatic fistula,with 1 patient having a biochemical fistula and 1 patient a grade B fistula.There was no grade C fistula.Other complications included 1 patient with delayed gastric emptying.There were no biliary fistula,no postoperative abdominal bleeding,and no perioperative death.Postoperative pathology showed 6 patients had lymph node metastases,with a positive lymph nodes rate of(4.8±4.4)%.All patients had R0 resection.The follow-up survival data of the 11 patients showed one patient to develop intrahepatic metastasis 1 month after operation and he died 9 months after operation.

关 键 词：腹腔镜 胰十二指肠切除术 No-touch 整块切除 胰头癌 

分 类 号：R735.9[医药卫生—肿瘤]