关键词: 腹腔镜, 胰十二指肠切除术, 手术适应证, 学习曲线, 胰腺全系膜切除, 联合血管切除重建

Abstract:

Several critical problems in laparoscopic pancreaticoduodenectomy        ZHANG Jian-sheng，WANG Wen-bin，LIU Jian-hua. Department of Hepatobiliary Surgery，the Second Hospital of Hebei Medical University，Shijiazhuang 050017，China
Corresponding author：LIU Jian-hua，E-mail: dr.ljh@outlook.com.
Abstract    In the last few decades，the safety and feasibility of laparoscopic pancreaticoduodenectomy(LPD) have been established and reported by multiple researchers. Compared with open surgery，the advantages of LPD include not only small incisions but a more precise surgical procedure. As the most challenging laparoscopic surgery，LPD still need to be developed and popularized. There are only a few clinical institutions regularly performing this operation and prospective multi-intitutional RCT of large sample remains lacking. Under the prerequisite of sufficient experiences in open pancreaticoduodenectomy（OPD） and professional skills of laparoscopic manipulation，after a relatively long learning curve，LPD could be regularly carried out. The standards of professional technique include GI tract reconstruction with pancreaticojejunostomy，lymphadenectomy combined with total mesopancreases excision and major vein segmental resection and reconstruction. At present，the indications for LPD are quite similar to open surgery at high-volume centers. However，given the extraordinary difficulty of this operation，surgeons should gradually perform LPD and select patients according to their own learning curve and technical conditions.

Key words: laparoscopy, pancreaticoduodenectomy, surgical indications, learning curve, total mesopancreases excision, major vascular resection and reconstruction