【摘要】 目的总结腹腔镜胰头十二指肠切除术在壶腹周围癌中应用的初步经验和体会。方法回顾性分析中国医科大学附属盛京医院胰腺外科2016年7月至2016年9月期间连续实施腹腔镜胰头十二指肠切除术治疗4例壶腹周围癌患者的临床资料。结果本组2例患者行完全腹腔镜下胰头十二指肠切除术,2例行腹腔镜下切除、小切口开放辅助吻合。所有病例均为R0切除。4例患者均行胰肠导管对黏膜吻合术。手术时间为510~600 min,术中出血量为400~600 m L,术后住院时间为15~21 d,术后下床活动时间为6~7 d。术后3例发生A级胰瘘,均经冲洗引流自愈;1例无胰瘘。4例患者均无术后出血、排空障碍、腹腔感染及胆汁漏发生,也无围手术期死亡患者。术后病理诊断:胰头导管腺癌1例,胰头钩突囊腺癌1例,十二指肠乳头癌1例,胆总管下端癌1例。结论从本研究有限病例的初步结果显示,腹腔镜胰头十二指肠切除术是安全、可行的,这种手术的开展和推广可以减少患者围手术期的心肺并发症,更早排气、进食和下床活动,更好地耐受手术,但手术并发症不能因此而减少。更多还原

【Abstract】 Objective To summarize preliminary experience of laparoscopic pancreaticoduodenectomy for periampullary carcinoma. Method The clinical data of patients with periampullary carcinoma underwent laparoscopic pancreaticoduodenectomy from July 2016 to September 2016 in the Shengjing Hospital of China Medical University were analyzed retrospectively. Results Two patients underwent complete laparoscopic pancreaticoduodenectomy, 2patients underwent laparoscopic resection and anastomosis assisted with small incision open. The R0 resection and duct to mucosa pancreaticojejunal anastomosis were performed in all the patients. The operative time was 510–600 min, intraoperative blood loss was 400–600 m L, postoperative hospitalization time was 15–21d, postoperative ambulation time was 6–7 d. Three cases of pancreatic fistula were grade A and all were cured by conservation. No postoperative bleeding, delayed gastric emptying, intra-abdominal infection, and bile leakage occurred. The postoperative pathological results showed that there was 1 case of pancreatic head ductal adenocarcinoma, 1 case of cyst adenocarcinoma of pancreas uncinate process, 1 case of papillary carcinoma of duodenum, and 1 case of terminal bile duct carcinoma. Conclusion The preliminary results of limited cases in this study show that laparoscopic pancreaticoduodenectomy has been proven to be a safe procedure, it could reduce perioperative cardiopulmonary complications, its exhaust time, feeding time, and postoperative ambulation time are shorter, but its operative complications could not be reduced.更多还原