腹腔镜保留十二指肠胰头切除术对比微创胰腺肿瘤剜除术治疗胰头良性或低度恶性肿瘤合并主胰管受累的围手术期预后  

Comparison of perioperative outcomes between laparoscopic duodenum-preserving pancreatic head resection and minimally invasive enucleation for benign or low-grade malignant tumors of the pancreatic head with main pancreatic duct involvement

作　　者：李征 史逸华 刘文生 卓奇峰 吉顺荣 周陈杰 虞先濬 徐晓武 LI Zheng;SHI Yihua;LIU Wensheng;ZHUO Qifeng;JI Shunrong;ZHOU Chenjie;YU Xianjun;XU Xiaowu(Department of Pancreatic Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Pancreatic Cancer Institute,Shanghai Key Laboratory of Precision Medicine for Pancreatic Cancer,Pancreatic Cancer Institute,Fudan University,Shanghai 200032,P.R.China)

机构地区：[1]复旦大学附属肿瘤医院胰腺外科、复旦大学上海医学院肿瘤学系、上海市胰腺肿瘤研究所、上海市胰腺肿瘤精准诊疗重点实验室、复旦大学胰腺肿瘤研究所,上海200032

出　　处：《中国普外基础与临床杂志》2025年第2期156-162,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金项目(项目编号:82373006,82403205);上海市卫生健康委员会卓越项目(项目编号:20224Z0006);上海市卫生健康委员会卫生行业临床研究专项(项目编号:20234Y0119)。

摘　　要：目的比较腹腔镜保留十二指肠胰头切除术(laparoscopic duodenum-preserving pancreatic head resection,LDPPHR)和微创胰腺肿瘤剜除术(minimally invasive enucleation,MIEN)在治疗胰头良性或低度恶性肿瘤中的围手术期结局。方法回顾性分析2021年3月至2024年11月期间,在复旦大学附属肿瘤医院接受LDPPHR(30例)和MIEN(38例)治疗患者的临床资料,比较LDPPHR和MIEN患者的围手术期结局。MIEN组患者的肿瘤术前评估均为部分或完全包绕主胰管。结果MIEN组的手术时间短于LDPPHR组(229.0 min vs.388.5 min,P<0.001),术中出血量也较少(100.0 mL vs.200.0 mL,P=0.028)。在主胰管的处理方面,MIEN组有26.3%(10/38)的患者主胰管保护完好未显露,10.5%(4/38)的患者主胰管显露但未损伤,7.9%(3/38)的患者主胰管损伤后进行单纯修补,55.3%(21/38)的患者主胰管损伤后置入支撑管修补重建。尽管MIEN组的术后胰瘘发生率高于LDPPHR组[B级胰瘘:73.7%(28/38)vs.43.3%(13/30)],但2组在其他围手术期结局(如术后住院时间、带管出院率、Clavien-Dindo并发症分级等)方面的差异均无统计学意义(P>0.05)。MIEN组中有1例患者因术后早期出血接受了再手术治疗。结论MIEN作为治疗合并主胰管受累的胰头良性或低度恶性肿瘤的可行手术方案,展现出优势,尤其在脏器功能保留和维持正常生理解剖方面。尽管胰瘘发生率较高,但与LDPPHR相比,其他围手术期结局未见显著差异。因此,MIEN在胰头部肿瘤的治疗中具有一定的应用前景,尤其适用于年轻且对功能保留有较高需求的患者。Objective To compare the perioperative outcomes of laparoscopic duodenum-preserving pancreatic head resection(LDPPHR)and minimally invasive enucleation(MIEN)in the treatment of benign or low-grade malignant tumors of the pancreatic head.Methods A retrospective analysis was conducted on the clinical data of patients who underwent LDPPHR(n=30)and MIEN(n=38)at Fudan University Shanghai Cancer Center between March 2021 and November 2024.The perioperative outcomes of the LDPPHR and MIEN groups were compared.Preoperative assessment of tumors in the MIEN group showed that they were partially or completely encircling the main pancreatic duct.Results The MIEN group had a significantly shorter operative time compared to the LDPPHR group(229.0 min vs.388.5 min,P<0.001),with less intraoperative blood loss(100.0 mL vs.200.0 mL,P=0.028).Regarding the management of the main pancreatic duct,26.3%(10/38)of patients in the MIEN group had an intact and unexposed main pancreatic duct,10.5%(4/38)had exposed but undamaged ducts,7.9%(3/38)had duct injury repaired with simple suture,and 55.3%(21/38)required stenting for duct repair and reconstruction following injury.Although the incidence of postoperative pancreatic fistula was higher in the MIEN group compared to the LDPPHR group[grade B:73.7%(28/38)vs.43.3%(13/30)],no significant differences were observed between the two groups in other perioperative outcomes(such as postoperative length of stay,discharge rate with drainage tube,and Clavien-Dindo complication grading,all P>0.05).One patient in the MIEN group required reoperation due to early postoperative hemorrhage.Conclusions MIEN is a feasible surgical option for treating benign or low-grade malignant pancreatic head tumors with involvement of the main pancreatic duct.It shows significant advantages,particularly in terms of preserving organ function and maintaining normal anatomical structures.Despite the higher incidence of pancreatic fistula,no significant differences were observed in other perioperative outcomes compared to LDP

关 键 词：胰头肿瘤 腹腔镜保留十二指肠胰头切除术 微创胰腺肿瘤剜除术 主胰管修补重建 围手术期预后 

分 类 号：R73[医药卫生—肿瘤]