应用动脉后弓优先入路行腹腔镜保留十二指肠胰头切除术12例临床分析  

Laparoscopic Duodenum-Preserving Pancreatic Head Resection with posterior arterial arch-first approach: an analysis of 12 cases

作　　者：钱道海 刘斌 金凯舟 叶龙云 吴伟顶 QIAN Dao-hai;LIU Bin;JIN Kai-zhou(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital),Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院)肝胆外科,安徽芜湖241001 [2]复旦大学附属肿瘤医院胰腺外科,上海200032

出　　处：《中国实用外科杂志》2023年第7期782-784,795,共4页Chinese Journal of Practical Surgery

基　　金：安徽省科技厅重点研究与开发计划项目(No.202004j07020051);弋矶山医院引进人才科研基金项目(No.YR202122)。

摘　　要：目的探讨动脉后弓优先入路应用于腹腔镜保留十二指肠胰头切除术(LDPPHR)的可行性及疗效。方法回顾性分析2021年6月至2023年2月皖南医学院弋矶山医院肝胆外科和复旦大学附属肿瘤医院胰腺外科收治的行LDPPHR的12例病人临床资料,术中均采用动脉后弓优先入路。所有病人术前影像学检查结果均为胰头良性肿瘤。结果12例接受LDPPHR的病人均顺利完成手术,无术中改行腹腔镜胰十二指肠切除术(LPD)或中转开放手术病例,手术时间为(341.0±80.6)min,术中出血225(100~800)mL,住院时间为14(7~28)d。术后出现3例生化漏,1例B级胰瘘,2例胆瘘。随访6(3~20)个月,无胆道狭窄发生。结论动脉后弓优先入路LDPPHR安全、可行,建议在有丰富LPD经验的大型胰腺外科中心开展。Objective To evaluate the application and efficacy of laparoscopic duodenum-preserving pancreatic head resection(LDPPHR)with arterial posterior arch-first approach.Methods The clinical data of 12 patients receiving LDPPHR from the Department of Hepatobiliary Surgery,Yijishan Hospital,Wannan Medical College and the Department of Pancreatic Surgery,Affiliated Cancer Hospital of Fudan University from June 2021 to February 2023 were analyzed retrospectively.All patients were treated with anterior arterial arch-first approach during surgery.Preoperative imaging of all patients showed benign pancreatic head tumors.Results All the 12 patients receiving LDPPHR were successfully operated and discharged from hospital without any conversion to Laparoscopic pancreaticoduodenectomy(LPD)or laparotomy.The average operation time was(341.0±80.6)min,the median intraoperative blood loss was 225(100~800)mL,the median postoperative hospital stay was 14(7~28)days.There were 3 cases of postoperative biochemical leakage,1 case of grade B pancreatic fistula,and 2 cases of biliary fistula.The median follow-up time was 6 months(range 3-20 months),and there was no case of biliary stenosis.Conclusion The posterior arterial arch-first approach is safe and feasible in LDPPHR,Suggest conducting in the large pancreatic surgery center with rich LPD experience.

关 键 词：保留十二指肠胰头切除术 腹腔镜 胰腺良性肿瘤 动脉后弓 手术入路 

分 类 号：R6[医药卫生—外科学]