原位腹腔镜胰十二指肠切除术的临床应用经验  

Clinical experience of laparoscopic pancreatoduodenectomy via orthotopic resection

作　　者：谭志健[1] 钟小生[1] 沈展涛[1] 黄有星[1] 陈彦辰[1] 仇成江[1] 陈桂豪 刘一峰 刘张苑珠 张生 林丽君[1] 蔡仕霞[1] 彭淑牖[2] Tan Zhijian;Zhong Xiaosheng;Shen Zhantao;Huang Youxing;Chen Yanchen;Qiu Chengjiang;Chen Guihao;Liu Yifeng;Liu Zhangyuanzhu;Zhang Sheng;Lin Lijun;Cai Shixia;Peng Shuyou(Pancreas Center,Guangdong Privincial Hospital of Chinese Medicine,Guangzhou 510120,China;Department of General Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310014,China)

机构地区：[1]广东省中医院胰腺中心,广州510120 [2]浙江大学医学院附属第二医院普通外科,杭州310014

出　　处：《中华外科杂志》2020年第10期782-786,共5页Chinese Journal of Surgery

基　　金：广东省中医院院内专项面上项目(YN2018ML01)。

摘　　要：目的探讨原位腹腔镜胰十二指肠切除术的临床应用效果。方法回顾性分析2019年3—12月广东省中医院胰腺中心连续收治的接受原位腹腔镜胰十二指肠切除术的32例患者资料。男性16例,女性16例,年龄(64.8±9.5)岁(范围:44~84岁),术前体重指数(21.7±3.5)kg/m^2(范围:14.9~31.0 kg/m^2)。所有患者术前均诊断为壶腹部或胰头占位,术前评估均为可切除肿瘤。手术策略中,先不进行Kocher游离,不翻转、不牵拉胰头十二指肠区域,通过中间和左后侧结合入路,优先原位解剖、离断入胰和出胰血管,离断淋巴管,隔绝肿瘤,最后才移动胰头十二指肠区域,进行整体切除,并采用Child法行消化道重建。采用门诊、电话或网络方式进行随访,术后每2~3个月门诊随访1次,了解患者术后生存情况及肿瘤复发转移情况。结果32例患者术后病理学检查结果显示,胰腺或壶腹部恶性肿瘤27例,良性肿瘤5例。手术时间(357.3±64.3)min(范围:217~566 min),胰管直径(3.0±1.0)mm(范围:1.5~5.0 mm)。胰腺质地软20例(62.5%)、质地硬12例(37.5%)。术后发生B级胰瘘5例(15.6%),未发生C级胰瘘、胆瘘、胃排空延迟,术后腹腔出血1例,无死亡病例。术后住院时间(13.7±3.6)d(范围:9~30 d)。结论原位腹腔镜胰十二指肠切除术中术者不接触肿瘤,在经过筛选后的患者中可获得较好的临床效果。Objective To examine the surgical approach,practical cognition as well as clinical effect of the orthotopic resection for laparoscopic pancreatoduodenectomy(OLPD).Methods From March 2019 to December 2019,32 cases were treated with laparoscopic pancreatoduodenectomy(LPD)in a novel approach without mobilization of pancreatoduodenum in Pancreas Center of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine.There were 16 male patients and 16 female patients.The mean age was(64.8±9.5)years old.Body mass index was 14.9 to 31.0 kg/m2.All patients were diagnosed as ampullary or pancreatic head tumors and were not unresectable cases.In the surgical strategy,Kocher's dissociation,turning and pulling of the pancreaticoduodenal region,was not performed first.Anatomy in situ,separation of vessels which enter and exit from pancreas,separation of lymphatics and isolation of tumors were carried out in priority through the combined middle and left posterior approaches.Finally,the pancreatic head and duodenum region was mobilized and the entire resection of pancreas in situ was carried out.Digestive tract reconstruction was performed through Child method.Results Postoperative pathology showed that 27 cases were pancreatic or ampullary malignant tumors and five cases were benign tumors among 32 patients.The operative time was(357.3±64.3)minutes.The diameter of pancreatic ducts was(3.0±1.0)mm.The pancreas of 20 cases(62.5%)were soft.Five patients suffered from pancreatic fistula(Grade B)and one patient suffered from intra-abdominal hemorrhage postoperatively.No other complications like pancreatic fistula(Grade C)or biliary fistula delayed gastric emptying or mortality were encountered.The postoperative hospital day was(13.7±3.6)days.Conclusions Combining the multi-angle of the laparoscopic approaches and excising the pancreaticoduodenal specimen in situ,OLPD is a kind of surgical method which can realize the concept of no touch tumor surgery.Patients who undergo the OLPD can receive better treatments and re

关 键 词：胰十二指肠切除术 腹腔镜 肠系膜上动脉 胰十二指肠下动脉 原位 

分 类 号：R657.5[医药卫生—外科学]