专题研究(Monographic Study)

3D腹腔镜胰十二指肠切除在壶腹周围癌治疗中的应用: 单团队经验

Published at: 2017年第26卷第9期

段小辉 1 , 周力学 1 , 田秉璋 1 , 杨建辉 1 , 李霞 1 , 曾颖慧 1 , 蒋波 1 , 毛先海 1
1 湖南省人民医院 肝胆外科,湖南 长沙 410005
通讯作者 先海 毛 Email: maoxianhai@yeah.net
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.09.008
基金:
湖南省教育厅科学研究重点基金资助项目 16A127
湖南省科技计划重点研发基金资助项目 2015sk2050

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(220~575)min,术中出血为175.9(100~550)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(8~29)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。


Three-dimensional laparoscopic pancreaticoduodenectomy for periampullary carcinoma: a single surgical team's experience

Abstract

Objective: To summarize the surgical experience in treatment of periampullary carcinoma by three-dimensional (3D) laparoscopic pancreaticoduodenectomy and its clinical efficacy. Methods: The clinical data of 101 patients with periampullary carcinoma undergoing 3D 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 loss was 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 in-hospital 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: 3D laparoscopic pancreaticoduodenectomy is safe and effective in treatment of periampullary carcinoma, with a favourable short-term outcome.


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引用

引用本文: 小辉 段, 力学 周, 秉璋 田, 建辉 杨, 霞 李, 颖慧 曾, 波 蒋, 先海 毛. 3D腹腔镜胰十二指肠切除在壶腹周围癌治疗中的应用: 单团队经验[J]. 中国普通外科杂志, 2017, 26(9): 1127-1132.
Cite this article as: DUAN Xiaohui, ZHOU Lixue, TIAN Bingzhang, YANG Jianhui, LI Xia, ZENG Yinghui, JIANG Bo, MAO Xianhai . Three-dimensional laparoscopic pancreaticoduodenectomy for periampullary carcinoma: a single surgical team's experience [J]. Chin J Gen Surg, 2017, 26(9): 1127-1132.