【摘要】 目的:总结3D腹腔镜胰十二指肠切除治疗壶腹周围癌的经验与临床疗效。方法:回顾性分析2014年1月—2017年3月101例在湖南省人民医院肝胆外科行3D腹腔镜胰十二指肠切除术的壶腹周围癌101例患者的临床资料。结果:全组平均手术时间为325.7（220⁵75）min,术中出血为175.9（100⁵50）mL。术后并发症包括胰瘘23例（22.8%）,其中生化瘘17例（16.8%）、B级胰瘘5例（5.0%）、C级胰瘘1例（1.0%）,术后出血7例（6.9%）,术后胆汁漏2例（3.0%）,胃排空延迟4例（4.0%）,腹腔感染6例（5.9%）,肺部感染3例（3.0%）,肠梗阻2例（2.0%）;Clavien并发症分级III级以上患者9例（8.9%）,其中3例患者行再次手术;住院30 d内死亡患者1例（1.0%）;术后平均住院时间14.8（8²9）d;术后病理为胆总管下端癌27例（26.7%）、壶腹部癌23例（22.8%）、十二指肠乳头癌39例（38.6%）、胰腺导管腺癌12例（11.9%）,肿瘤直径（2.3±1.3）cm,R₀切除率95.0%,淋巴结清扫数目为（16.7±4.2）枚,其中阳性淋巴结为（1.3±1.1）枚。结论:3D腹腔镜胰十二指肠切除治疗壶腹周围癌安全可行,近期疗效良好。更多还原

【Abstract】 Objective: To summarize the surgical experience in treatment of periampullary carcinoma by three-dimensional(3 D) laparoscopic pancreaticoduodenectomy and its clinical efficacy.Methods: The clinical data of 101 patients with periampullary carcinoma undergoing 3 D laparoscopic pancreaticoduodenectomy from January 2014 to March 2017 in Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital were retrospectively analyzed.Results: In the entire group, the average operative time was 325.7(220–575) min and intraoperative blood losswas 175.9(100–550) mL; postoperative complications included pancreatic fistula in 23 patients(22.8%) which were classified as biochemical fistula in 17 cases(16.8%), grade B pancreatic fistula in 5 cases(5.0%) and grade C pancreatic fistula in 1 case(1.0%), intra-abdominal bleeding in 7 patients(6.9%), bile leakage in 2 cases(2.0%),delayed gastric emptying in 4 cases(4.0%), intra-abdominal infection in 6 cases(5.9%), pulmonary infection in 3 cases(3.0%) and intestinal obstruction in 2 cases(2.0%); grade 3 complications according to Clavien classification were found in 9 patients(8.9%), of whom 3 cases required a repeated operation, and the 30-day inhospital death occurred in one patient(1.0%). The average length of postoperative hospital stay was 14.8(8–29) d.Postoperative pathological data showed that 27 patients(26.7%) had distal common bile duct cancer, 23 patients(22.8%) had ampullary carcinoma, 39 patients(38.6%) had duodenal papillary carcinoma, and 12 patients(11.9%)pancreatic ductal adenocarcinoma; the average tumor diameter was(2.3±1.3) cm, R0 resection rate was 95.0%,and the number of removed lymph nodes was 16.7±4.2, with the number of positive lymph nodes of 1.3±1.1.Conclusion: 3 D laparoscopic pancreaticoduodenectomy is safe and effective in treatment of periampullary carcinoma, with a favourable short-term outcome.更多还原