腹腔镜胰十二指肠切除术在治疗胰腺癌中的价值和争议  

The value and controversy of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic cancer

作　　者：尹韬远 张航 王敏[1] 秦仁义[1] Yin Taoyuan;Zhang Hang;Wang Min;Qin Renyi(Department of Biliary-Pancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华外科杂志》2022年第10期894-899,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81772950,82073249,81773160);湖北省重点研发计划(2021BCA117);同济医院临床研究领航项目(2019CR203)。

摘　　要：胰腺癌曾被认为是腹腔镜胰十二指肠切除术的禁忌证,但大量研究结果表明,腹腔镜胰十二指肠切除术在大型胰腺外科中心由度过学习曲线的外科医师开展,是安全可行的。腹腔镜胰十二指肠切除术可提供高分辨率的术中探查视野和独特的操作视角,有助于减少术中和术后并发症,更彻底地清扫淋巴结并减少肿瘤的术中转移,进而推进术后辅助治疗的开展,最终改善患者的生活质量。由于学习曲线漫长,患者生存结局不确定,腹腔镜胰十二指肠切除术在胰腺癌患者中的应用仍然存在争议。本文总结了现有的文献报道和作者团队的经验,探讨腹腔镜胰十二指肠切除术应用于胰腺癌治疗的价值和争议,并就提升我国腹腔镜胰十二指肠切除术的开展水平提出建议。Pancreatic cancer was considered to be one of the contraindications of laparoscopic pancreaticoduodenectomy,but a large number of studies have shown that laparoscopic pancreaticoduodenectomy is safe and feasible for surgeons who have passed the learning curve in high-volume hospitals.Laparoscopic pancreaticoduodenectomy can provide high-resolution intraoperative exploration and unique operative perspective,which can help to reduce intraoperative and postoperative complications,dissect lymph nodes more thoroughly and reduce intraoperative metastasis of tumors,so as to promote the development of postoperative adjuvant therapy and improve patients′quality of life.However,due to the long learning curve and unclear survival outcome,the application of laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer is still controversial.This article summarizes the existing literature and the experience of the author′s team,exploring the value and controversy of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic cancer.Further,suggestions are put forward on how to improve the laparoscopic pancreaticoduodenectomy in China.

关 键 词：胰腺肿瘤 胰十二指肠切除术 腹腔镜手术 开腹手术 

分 类 号：R735.9[医药卫生—肿瘤]