多支架置入后3D腹腔镜下胰腺钩突肿瘤局部切除术的临床经验  

Experience of 3D laparoscopic local resection of pancreatic uncinate process tumors after multiple stent placement

作　　者：胡伟建 葛佳皓 周海华 李仓 厉学民 俞世安 吴晓康 HU Weijian;GE Jiahao;ZHOU Haihua;LI Cang;LI Xuemin;YU Shian;WU Xiaokang(Department of Hepatobiliary Pancreatic Surgery,the Affiliated Jinhua Hospital of Zhejiang University,Jinhua,Zhejiang 321099,China)

机构地区：[1]浙江大学医学院附属金华医院肝胆胰外科,浙江金华321099

出　　处：《肝胆胰外科杂志》2024年第6期337-340,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省医药卫生科技项目一般项目(2023KY382);金华市科技计划项目社会发展类重点项目(2022-3-090)。

摘　　要：目的探讨多支架置入后3D腹腔镜下胰腺钩突肿瘤局部切除治疗胰腺良性及低度恶性肿瘤的围手术期安全性及可行性。方法回顾分析2019年3月至2023年6月浙江大学医学院附属金华医院收治的8例多支架置入后3D腹腔镜下胰腺钩突肿瘤局部切除术患者的临床资料。结果8例患者均于术前1 d在内镜逆行胰胆管造影术(ERCP)下放置胆胰管或胰管支架,全部成功实施完全腹腔镜下钩突肿瘤局部切除术,无中转开腹,切除肿瘤边界完整。平均术中出血量(112.5±44.3)mL,手术时间(248.0±36.8)min,术后住院时间(12.2±3.4)d。术后发生胰瘘4例,其中生化漏2例,B级胰瘘2例,未发生C级胰瘘,无围手术期死亡病例。术后病理报告显示浆液性囊腺瘤1例,实性假乳头状瘤2例,IPMN伴低级别上皮内瘤变3例,神经内分泌肿瘤(G1)2例。结论对于胰腺钩突部位良性或低度恶性肿瘤,多支架置入后行3D腹腔镜下肿瘤局部切除术手术创伤小,围手术期并发症少,治疗效果好,是一项安全可行的术式。Objective To explore the perioperative safety and feasibility of 3D laparoscopic local resection of tumors located in the pancreatic uncinate process tumors following multiple stent placement for treating benign and low-grade malignant pancreatic tumors.Methods The clinical data of 8 patients who underwent 3D laparoscopic local resection of pancreatic uncinate process tumors after multiple stent placements between Mar.2019 and Jun.2023 were retrospectively analyzed.Results All the 8 patients successfully underwent complete laparoscopic local resection of pancreatic uncinate process tumors with biliopancreatic duct stent placement prior to surgery.None of the patients required conversion to open surgery,and all tumors were resected with clear margins.The average intraoperative bleeding was(112.5±44.3)mL,the surgical time was(248.0±36.8)min,and the postoperative hospitalization time was(12.2±3.4)d.Four cases experienced pancreatic fistula,with 2 cases of biochemical leakage and 2 cases of grade B pancreatic fistula,but no grade C pancreatic fistula,or perioperative deaths were reported.Postoperative pathological reports showed 1 case of plasma cystadenoma,2 cases of solid pseudopapillary tumor,3 cases of IPMN with low-grade intraepithelial neoplasia and 2 cases of neuroendocrine tumor(G1).Conclusion 3D laparoscopic local resection is a safe and feasible surgical option for pancreatic benign or low-grade malignant tumors following multiple stent placement.The study suggests that this procedure can be performed with less trauma and fewer perioperative complications to patients.

关 键 词：胰腺钩突肿瘤 腹腔镜手术 局部切除术 胆胰管支架 胰瘘 

分 类 号：R735.9[医药卫生—肿瘤] R657.5[医药卫生—临床医学]