完全腹腔镜胰十二指肠切除术及全胰切除术联合门静脉-肠系膜上静脉切除重建可行性及安全性分析  

Feasibility and safety analysis of laparoscopic pancreaticoduodenectomy and total pancreatectomy combined with portal vein-superior mesenteric vein resection and reconstruction

作　　者：孙蒙清 陈少博 洪夏飞 董良博 何小东[1] 韩显林[1] SUN Meng-qing;CHEN Shao-bo;HONG Xia-fei(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing100005,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100005

出　　处：《中国实用外科杂志》2024年第2期199-204,共6页Chinese Journal of Practical Surgery

基　　金：中央高水平医院临床科研业务费资助项目(No.2022-PUMCH-B-003);国家重大疾病多学科合作诊疗能力建设项目。

摘　　要：目的 探讨完全腹腔镜胰十二指肠切除术(LPD)及腹腔镜全胰切除术(LTP)联合门静脉-肠系膜上静脉(PV-SMV)切除重建的技术要点,及其安全性、可行性和根治性。方法 回顾性分析2022年5月至2023年9月在中国医学科学院北京协和医院接受LPD及LTP联合PV-SMV切除重建手术的13例病人临床资料。结果 13例病人中,10例病人行LPD,3例病人行LTP。7例(53.8%)病人行PV-SMV侧壁切除缝合,4例(30.8%)病人行PV-SMV节段切除、对端吻合,2例(15.4%)病人行PV-SMV节段切除、人工血管搭桥。手术时间(314.2±70.5)min。术中出血量(442.3±247.4)mL。PV-SMV中位阻断时间22(8~80)min。术后1例病人发生胃排空延迟,未发生B级以上胰瘘、术后出血、腹腔感染、胆瘘、二次手术、急性血栓栓塞事件及30 d内围手术期死亡。术后住院时间(10.7±4.7)d。术后病理学检查结果显示:1例为胰腺伴有破骨巨细胞的未分化癌,12例为胰腺导管腺癌。标本肿瘤大小(3.9±1.6)cm。术中淋巴结清扫(25.7±12.7)枚。淋巴结转移9例(69.2%)。术后病理学检查证实侵犯门静脉者5例(38.5%)。所有病人均为R0切除。术后门静脉通畅率100.0%。结论 对于经验丰富的微创胰腺手术团队,在合理选择适应证的基础上,LPD或LTP联合PV-SMV切除重建用于部分胰头癌侵犯PV-SMV的病人是安全可行的,可提高肿瘤的R0切除率,使病人获益。Objective To analyze technical highlights,safety and feasibility of laparoscopic pancreaticoduodenectomy(LPD) and laparoscopic total pancreatectomy(LTP) combined with portal vein-superior mesenteric vein(PV-SMV)resection and reconstruction.Methods The clinical data of 13 patients who underwent LPD and LTP combined with PV-SMV resection and reconstruction in Peking Union Medical College Hospital from May 2022 to September 2023 were retrospectivly analyzed.Results Among the 13 patients,10 underwent LPD,and 3 underwent LTP.Seven patients(53.8%)underwent PV-SMV sidewall resection and closure,4 patients(30.8%)underwent PV-SMV segmental resection with end-to-end anastomosis,and 2 patients(15.4%)underwent PV-SMV segmental resection with artificial vascular bridging.The mean operative time was(314.2±70.5) minutes,with intraoperative blood loss of(442.3±247.4)mL.The median PV-SMV occlusion time was 22(8-80)minutes.One patient experienced delayed gastric emptying postoperatively.There was no occurrences of grade B or higher pancreatic fistula,postoperative bleeding,intra-abdominal infection,bile leakage,reoperation,acute thromboembolic events,or perioperative death within 30 days in this study.The mean postoperative hospital stay was(10.7±4.7) days.Pathological examination revealed one case of undifferentiated carcinoma with giant cells in the pancreas and 12 cases of pancreatic ductal adenocarcinoma.The mean tumor size was(3.9±1.6) cm.Intraoperatively,(25.7±12.7) lymph nodes were dissected,with lymph node metastasis observed in 9 cases(69.2%).Postoperative pathological examination confirmed portal vein invasion in 5 cases(38.5%).All patients achieved R0 resection.Postoperative portal vein patency rate was 100.0%.Conclusion For experienced minimally invasive pancreatic surgery teams,LPD or LTP combined with PV-SMV resection and reconstruction is safe and feasible for patients with PV-SMV involvement in selected cases of pancreatic head cancer,improving the R0 resection rate and benefiting the patients.

关 键 词：腹腔镜胰十二指肠切除术 腹腔镜全胰切除术 胰腺癌 门静脉-肠系膜上静脉切除重建 

分 类 号：R6[医药卫生—外科学]