目的：探讨钩突入路腹腔镜胰十二指肠切除术的临床应用价值。 方法：回顾性分析2010年2月以来完成的12例钩突入路法腹腔镜胰十二指肠切除术患者资料。手术要点是于十二指肠水平部沿肠系膜上动脉右侧从下往上解离胰腺钩突部及其系膜，再依次完成其他手术步骤。 结果：12例患者中2例中转开腹，其余顺利完成手术。手术时间240~340 min，平均280 min；术中出血150~1 200 mL，平均300 mL；清除淋巴结9~15枚，平均10枚。术后病理检查示标本切缘阴性。术后并发胰瘘2例，胆瘘1例，经处理后痊愈。 结论：钩突入路腹腔镜胰十二指肠切除术是安全、可行、有效的手术方式。
Laparoscopic pancreaticoduodenectomy with uncinate process approach: a report of 12 cases
Objective: To determine the clinical application value of laparoscopic pancreaticoduodenectomy (PD) with an uncinate process approach. Methods: The clinical data of 12 patients undergoing laparoscopic PD with uncinate process approach since February 2010 were reviewed. The essential feature of the operation was dissection of the uncinate process and the mesentery upwards along the right side of the superior mesenteric artery from the horizontal part of the duodenum, and then proceeding to conduct the other surgical procedures in the conventional order. Results: Of the 12 patients, 2 cases were converted to open surgery, and remaining 10 cases had successful laparoscopic PD. The operative time for laparoscopic PD was 240 to 340 min with an average of 280 min, the intraoperative blood loss was 150 to 1 200 mL with an average of 300 mL, and the number of dissected lymph nodes was 9 to 15 with an average number of 10. Postoperative pathological examination showed negative surgical margins. Postoperative pancreatic leakage and bile leakage occurred in 2 patients and 1 patient respectively, which were all cured after treatment. Conclusion: Laparoscopic PD with uncinate process-first approach is a safe, feasible and effective surgical procedure.