低容量胰腺中心腹腔镜胰十二指肠切除术42例治疗体会  

Surgical experience of laparoscopic pancreaticoduodenectomy in a low-volume pancreatic center with 42 cases

作　　者：陆轶杰 李松 蒋新卫[1] 吴建武[1] LU Yijie;LI Song;JIANG Xingwei;WU Jianwu(Department of Hepatobiliary Surgery,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou,Jiangsu 215000,China)

机构地区：[1]南京医科大学附属苏州医院肝胆外科,江苏苏州215000

出　　处：《肝胆胰外科杂志》2023年第12期726-730,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：苏州市临床医学中心项目(Szlcyxzxj202107)。

摘　　要：目的探讨并总结低容量胰腺中心腹腔镜胰十二指肠切除术(LPD)的相关手术经验及体会。方法回顾性分析2020年5月至2023年5月在南京医科大学附属苏州医院行LPD的42例患者临床资料,其中男23例,女19例,平均年龄(65.4±9.6)岁。结果36例顺利完成LPD,6例中转开腹胰十二指肠切除术,平均手术时间(302.6±41.6)min,胰肠吻合时间(16.3±3.0)min,中位术中出血量210(200,340)mL,术后平均住院时间(21.1±4.2)d。术后生化漏15例,B级胰瘘4例,C级胰瘘1例。病理学结果提示胰腺导管腺癌22例,胆管癌5例,壶腹部癌7例,十二指肠腺癌8例。结论LPD手术方式复杂,学习曲线长,术者需具备丰富的腔镜手术经验,但通过对胰肠吻合方式的不断改良及大网膜衬垫技术的应用,可逐渐缩短手术时间,提高手术安全性并顺利渡过学习曲线,使低容量胰腺中心能够顺利开展LPD。Objective To discuss and summarize the surgical experience of laparoscopic pancreaticoduodenectomy(LPD)in a low-volume pancreatic center.Methods A retrospective analysis was performed on the clinical data of 42 patients who underwent LPD from May 2020 to May 2023 in Affiliated Suzhou Hospital of Nanjing Medical University.Among them,23 were male and 19 were female,with average age(65.4±9.6)years.Results LPD were performed successfully in 36 cases;the other 6 cases were converted to open pancreaticoduodenectomy.The average operation time was(302.3±41.6)min,and the pancreaticojejunostomy time was(16.3±3.0)min.The median blood loss was 210(200,340)mL.The average postoperative hospitalization time was(21.1±4.2)d.Postoperative complications included 15 cases of biochemical leakage(no special treatment required),4 cases of grade B pancreatic fistula and 1 case of grade C pancreatic fistula.Pathological results showed that there were 22 cases of pancreatic ductal adenocarcinoma,5 cases of cholangiocarcinoma,7 cases of adenocarcinoma perampullaire and 8 cases of duodenal adenocarcinoma.Conclusion LPD is a complex surgical procedure with a relatively longer learning curve.Sufficient experience in laparoscopic surgery is necessary before conducting LPD.Certain optimization of pancreaticojejunostomy,with application of the omental pad,these measures can gradually shorten the operation time,improve surgical safety and smoothly navigate the learning curve,enabling low-volume pancreatic centers to smoothly carry out LPD.

关 键 词：腹腔镜手术 胰十二指肠切除术 改良胰肠吻合 低容量胰腺中心 

分 类 号：R735.9[医药卫生—肿瘤]