腹腔镜根治性顺行模块化胰脾切除术在胰体尾癌治疗中的初步经验(附5例报告)  

Preliminary experience of laparoscopic radical antegrade modular pancreatos-plenectomy in the treatment of pancreatic body and tail cancer(report of 5 cases)

作　　者：王仰亮 韩冰[1] 翟振洪 李昌[1] WANG Yangliang;HAN Bing;ZHAI Zhenhong;LI Chang(Hepatobiliary Surgery Department,Shanxian Central Hospital,Heze 274300,China)

机构地区：[1]单县中心医院肝胆外科,山东菏泽274300

出　　处：《临床医学研究与实践》2023年第5期8-11,共4页Clinical Research and Practice

摘　　要：目的总结腹腔镜根治性顺行模块化胰脾切除术(L-RAMPS)在胰体尾癌治疗中的初步经验。方法收集2021年4月至2022年6月5例术前诊断为胰体尾癌行L-RAMPS患者的临床相关资料,统计手术相关数据、术后并发症及病理情况。结果5例患者均在完全腹腔镜下顺利完成手术,无住院期间或术后30 d死亡病例。平均手术时间(172.23±25.68)min,平均标本切除时间(148.15±21.46)min,平均术中出血量(131.54±82.79)mL。术后平均下床活动时间(2.14±0.32)d,平均排气时间(2.79±0.17)d,平均进食时间(3.57±0.61)d,平均住院时间(13.71±4.35)d,平均肿瘤最大径(3.87±2.13)cm。术后2例发生胰瘘,胃排空障碍1例,经保守治疗痊愈。病理示:胰腺导管腺癌4例(其中高分化1例,低分化3例),胰腺神经内分泌癌1例;T2期4例,T1期1例;TNM分期(AJCC,8版)ⅠB期3例,ⅡA期1例,ⅡB期1例;平均淋巴结清扫数目(15.31±1.16)枚,淋巴结阳性2例,阳性率为40%。5例患者均获得R0切除,无再次手术病例。结论L-RAMPS技术要求高,手术难度大,治疗胰体尾癌安全可行,可提高胰体尾癌患者淋巴结清扫数量和R0切除率,值得临床推广。Objective To summarize the preliminary experience of laparoscopic radical antegrade modular pancreatectomy(L-RAMPS)in the treatment of pancreatic body and tail cancer.Methods The clinical data of 5 patients who underwent L-RAMPS for pancreatic body and tail cancer from April 2021 to June 2022 were collected,and the surgical data,postoperative complications and pathological conditions were statistically analyzed.Results All the 5 patients successfully completed the operation under complete laparoscopy without death during hospitalization or 30 d after operation.The average operation time was(172.23±25.68)min,the average specimen resection time was(148.15±21.46)min,and the average intraoperative blood loss was(131.54±82.79)mL.The average postoperative ambulation time was(2.14±0.32)d,the average exhaust time was(2.79±0.17)d,the average eating time was(3.57±0.61)d,the average hospital stay time was(13.71±4.35)d,and the average maximum diameter of tumor was(3.87±2.13)cm.Postoperative pancreatic fistula occurred in 2 cases,and gastric emptying disorder occurred in 1 case,which were cured by conservative treatment.Pathology showed that 4 cases of pancreatic ductal adenocarcinoma(including 1 case of high differentiation and 3 cases of low differentiation),and 1 case of pancreatic neuroendocrine carcinoma;there were 4 cases in T2 stage and 1 case in T1 stage;TNM staging(AJCC,8th edition)was stageⅠB in 3 cases,stageⅡA in 1 case and stageⅡB in 1 case;the average number of lymph node dissection was(15.31±1.16),and 2 cases had positive lymph nodes,with a positive rate of 40%.All 5 patients received R0 resection,and no reoperation was performed.Conclusion L-RAMPS has high technical requirements and is difficult to operate.It is safe and feasible to treat pancreatic body and tail cancer.It can improve the number of lymph node dissection and R0 resection rate in patients with pancreatic body and tail cancer,which is worthy of clinical promotion.

关 键 词：腹腔镜根治性顺行模块化胰脾切除术 胰体尾癌 淋巴结清扫数量 

分 类 号：R735.9[医药卫生—肿瘤]