联合门静脉系统切除重建LPD的安全性和可行性分析  

Analysis of the safety and feasibility of combined portal vein system resection and reconstruction in laparoscopic pancreaticoduodenectomy

作　　者：杜成旭 于灏天 李冬瑞[1] 赵伟红[1] 刘建华[1] 张建生[1] 王文斌[1] 边伟[1] 吕海涛[1] Du Chengxu;Yu Haotian;Li Dongrui;Zhao Weihong;Liu Jianhua;Zhang Jiansheng;Wang Wenbin;Bian Wei;Lyu Haitao(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000

出　　处：《中华肝胆外科杂志》2025年第2期107-110,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：河北省医学科学研究课题(20240031)。

摘　　要：目的探讨联合门静脉系统切除重建腹腔镜胰十二指肠切除术(LPD)的安全性和可行性。方法回顾性分析2016年1月至2023年12月在河北医科大学第二医院肝胆外科行联合门静脉系统切除重建LPD的26例胰头癌或胆管远端恶性肿瘤患者的临床资料,其中男性13例,女性13例,年龄63.0(57.2,66.0)岁。记录患者的手术时间、术中出血量及输血量、血流阻断时间、术后并发症情况、重症监护病房(ICU)住院时间、住院时间等临床资料。结果26例患者手术均顺利完成。手术时间(483.65±118.00)min,术中出血量1100(625,2750)ml,术中输血量为600(438,1050)ml,门静脉系统阻断时间(35.00±6.00)min。中转开腹5例(19.2%,5/26),完成门静脉系统部分切除后修补5例(19.2%,5/26),门静脉系统端端吻合12例(46.1%,12/26),人工血管置换9例(34.6%,9/26)。术后B级胰瘘1例(3.8%,1/26),胆漏3例(11.5%,3/26),胃瘫1例(3.8%,1/26),肠梗阻3例(11.5%,3/26),腹部感染2例(7.7%,2/26),术后出血2例(7.7%,2/26),二次手术1例(3.8%,1/26),围术期死亡1例(3.8%,1/26)。术后住院时间14.00(12.00,20.75)d,ICU住院时间3.0(1.0,6.5)d,肿瘤长径4.00(3.00,5.38)cm,阳性淋巴结数量1.0(0.5,3.5)个。结论联合门静脉系统切除重建的LPD治疗胰头癌或胆管远端恶性肿瘤患者安全有效。Objective To explore the safety and feasibility of laparoscopic pancreaticoduodenectomy(LPD)combined with portal vein system resection and reconstruction.Methods The clinical data of 26 patients with pancreatic head cancer or distal bile duct malignant tumors who underwent reconstructive LPD combined with portal vein resection in the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from January 2016 to December 2023 were retrospectively analyzed,including 13 males and 13 females,aged 63.0(57.2,66.0)years.The clinical data of the patients,including the operation time,intraoperative blood loss and blood transfusion,blood flow interruption time,postoperative complications,intensive care unit(ICU)admission time,and hospital stay were recorded.Results All 26 patients had completed the operation successfully.The operation time was(483.65±118.00)min,the intraoperative blood loss was 1100(625,2750)ml,the intraoperative blood transfusion was 600(438,1050)ml,and the portal vein system blockade time was(35.00±6.00)min.There were 5 cases(19.2%,5/26)with laparotomy,5 cases(19.2%%,5/26)with repair after partial resection of the portal vein system,12 cases(46.1%,12/26)with end-to-end anastomosis of the portal venous system,and 9 cases(34.6%,9/26)with artificial vascular replacement.There was 1 case of grade B pancreatic fistula(3.8%,1/26),3 cases of bile leakage(11.5%,3/26),1 case of gastric paralysis(3.8%,1/26),3 cases of intestinal obstruction(11.5%,3/26),2 cases of abdominal infection(7.7%,2/26),2 cases of postoperative bleeding(7.7%,2/26),1 case of secondary surgery(3.8%,1/26),and 1 case of perioperative death(3.8%,1/26).The postoperative hospital stay was 14.00(12.00,20.75)d,the ICU length of stay was 3.0(1.0,6.5)d,the tumor length diameter was 4.00(3.00,5.38)cm,and the number of positive lymph nodes was 1.0(0.5,3.5).Conclusion LPD reconstructed with portal system resection is a safe and effective treatment of patients with pancreatic head cancer or distal bile duct malignancy.

关 键 词：腹腔镜 血管切除重建 胰十二指肠切除术 

分 类 号：R73[医药卫生—肿瘤]