腹腔镜和机器人时代保留胰腺实质手术的机遇和挑战  

Opportunities and challenges of parenchyma-preserving pancreatectomy in the era of laparoscopy and robot

作　　者：蒋斌[1] 修典荣[1] Jiang Bin;Xiu Dianrong(Department of General Surgery,the Third Affiliated Hospital of Beijing University,Beijing 100091,China)

机构地区：[1]北京大学第三医院普通外科,100091

出　　处：《国际外科学杂志》2021年第6期361-365,共5页International Journal of Surgery

摘　　要：胰腺良性和低度恶性肿瘤发病率的上升和早期诊断给胰腺外科医师提出了新的挑战。外科技术的进展提高了胰腺手术的安全性,手术适应证逐步扩大。术后患者的长期生存使胰腺的功能保护成为热点。对于直径较小,无侵袭性的良性或低度恶性肿瘤,保留胰腺实质的手术已成为很多医学中心的首选。胰腺局部切除术包括胰腺肿瘤剜除术、胰腺中段切除术和保留十二指肠的胰头部分或全切术。从目前的研究结果来看,胰腺局部切除术后的胰腺内外分泌功能不足的发生率均显著低于胰十二指肠切除术和胰腺远段切除术。胰腺肿瘤剜除术和保留十二指肠的胰头部分或全切术术后并发症发生率较高,但大多为A级胰瘘,安全性较高。胰腺中段切除术后严重并发症发生率明星高于远段胰腺切除术。腹腔镜或机器人的胰腺局部切除术具备微创优势,镜下视野的放大也有利于主胰管的保护,较开腹手术更适合胰腺的局部切除手术。The increasing incidence and early diagnosis of benign and low grade malignant tumor have presented new challenge to surgeons.Nowadays the safety of pancreatic surgery are warranted due to the progress of surgical techniques,resulting in the expansion of surgical indications.The long survival time post-operation of benign or low grade malignant tumors makes the preservation of endocrine and exocrine function of pancreas more and more important,and the parenchyma-preserving pancreatectomy has been increasing used at experienced medical center,including enucleation,central pancreatectomy and duodenum preserving pancreatic head resection.Compared with pancreaticoduodenectomy and distal pancreatectomy,significantly less patients suffered from endocrine and exocrine insufficiency after local resection of pancreas.More complications was observed after enucleation and duodenum preserving pancreatic head resection,mostly grade A pancreatic fistula,with low rate of mortality.Central pancreatectomy was associated with significantly more severe complications,compared with distal pancreatectomy.Laparoscopic or robotic local resection of pancreas are minimally invasive,and more suitable for the protection of main pancreatic duct with amplifying visions,and is more suitable for local resection of the pancreas than open surgery.

关 键 词：保留实质的切除术 胰腺局部切除术 微创手术 

分 类 号：R735.9[医药卫生—肿瘤]