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目的总结腹腔镜胰十二指肠切除术(LPD)在壶腹周围癌中的应用。方法回顾性分析浙江省人民医院肝胆胰外科及微创外科自2013年12月至2016年1月期间实施LPD治疗壶腹周围癌51例患者的临床资料。结果本组51例患者中48例手术获成功,3例中转开腹。手术时间为(370±104)min,术中出血量为(220.7±180.9)m L。5例患者行胰胃捆绑式吻合术,其余46例患者行胰肠导管对黏膜吻合术,其中行LRPD的患者均采用胰肠导管对黏膜吻合术。术后住院时间为(14.6±11.2)d。术后9例患者出现胰瘘,2例腹腔内出血,2例消化道出血,4例胃排空障碍,4例胆漏。术后病理诊断:胰头导管腺癌28例,十二指肠乳头癌12例,胆总管下端和壶腹部癌11例。经术中冰冻及术后病理学检查证实,所有病例均为R0切除。结论微创胰十二指肠切除技术已成熟,按照我们提出的淋巴结清扫路径能提高淋巴结清扫的效率,必要时联合血管切除,可以有效提高R0切除率,改善壶腹周围恶性肿瘤患者的预后。
Objective To summarize the application of laparoscopic pancreatoduodenectomy (LPD) in periampullary carcinoma. Methods The clinical data of 51 patients with periampullary carcinoma treated with LPD from December 2013 to January 2016 in Zhejiang Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery Department of Zhejiang Provincial People’s Hospital were retrospectively analyzed. Results In this group of 51 patients, 48 cases were successfully operated and 3 cases were converted to open surgery. The operation time was (370 ± 104) min and the blood loss was (220.7 ± 180.9) m L. Five patients underwent pancreatico-gastric anastomosis. The remaining 46 patients underwent pancreatico-pancreatic ductal mucosal anastomosis. Among them, patients undergoing LRPD received pancreatic ductal catheterization for mucosal anastomosis. The postoperative hospital stay was (14.6 ± 11.2) days. Pancreatic fistula, 2 cases of intraperitoneal hemorrhage, 2 cases of gastrointestinal bleeding, 4 cases of gastric emptying disorder and 4 cases of bile leakage occurred in 9 cases. Postoperative pathological diagnosis: pancreatic ductal adenocarcinoma in 28 cases, duodenal papillary carcinoma in 12 cases, common bile duct and ampullary carcinoma in 11 cases. The intraoperative frozen and postoperative pathological examination confirmed that all cases were R0 resection. Conclusion Minimally invasive pancreaticoduodenectomy is mature. According to our proposed path of lymph node dissection, the efficiency of lymphadenectomy can be improved. If necessary, combined with vascular resection, it can effectively improve R0 resection rate and improve the prognosis of patients with malignant tumor around ampulla.