中国实用外科杂志

中国实用外科杂志

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“结肠后入路-钩突先行”在腹腔镜胰十二指肠切除术中应用研究

陈庆民，刘松阳，王英超，张    威，刘    凯，纪    柏，刘亚辉   

  1. 吉林大学第一医院肝胆胰外二科，吉林长春 130021
  • 出版日期:2019-12-01 发布日期:2019-12-23

  • Online:2019-12-01 Published:2019-12-23

摘要： 目的    探讨“结肠后入路-钩突先行”在腹腔镜胰十二指肠切除术中应用的价值。方法    回顾性分析自2015年4月至2018年10月在吉林大学第一医院肝胆胰外科二科行腹腔镜胰十二指肠切除术的200例病例资料，在标本切除阶段均采用“结肠后入路-钩突先行”。结果    200例病人均成功完成腹腔镜胰十二指肠切除术，其中1例行腹腔镜胰十二指肠切除联合右半结肠切除术，2例行腹腔镜胰十二指肠切联合胰体尾切除术，2例行腹腔镜胰十二指肠切除联合门静脉重建（端端吻合）。平均手术时间（281±49）min，其中标本切除时间（91±15）min，术中出血量50～850 mL，平均（122±53）mL；术后平均住院时间（16±9） d；术后B级胰瘘18例（9.0%），C级胰瘘3例（1.5%）；术后吻合口出血2例（1.0%）；腹腔内出血14例（7.0%）；胃排空延迟9例（4.5%）；胆瘘11例（5.5%）；死亡2例（1.0%）。术后病理学诊断：胰头导管腺癌33例（16.5%），胰腺导管内乳头状黏液肿瘤15例（7.5%），胰头神经内分泌肿瘤6例（3.0%），胰腺导管上皮异型增生1例（0.5%），胰头实性假乳头状瘤9例（4.5%），胰头囊腺瘤5例（2.5%），慢性胰腺炎1例（0.5%），十二指肠腺癌4例（2.0%），十二指肠间质瘤2例（1.0%），十二指肠良性占位性病变11例（5.5%），非胰头来源的壶腹周围癌105例（52.5%），壶腹周围良性肿瘤9例（4.5%）。结论“结肠后入路-钩突先行”在腹腔镜胰十二指肠切除术中具有安全、快速、有效的特点，值得临床进一步推广和应用。

关键词: 胰十二指肠切除术, 腹腔镜技术, 手术入路

Abstract: Application of "priority approach of uncinate process" in laparoscopic pancreaticoduodenectomy： A report of 200 cases        CHEN Qing-min, LIU Song-yang, WANG Ying-chao, et al. No.2 Department of Hepatobiliarypancreatic Surgery, the First Hospital of Jilin University,Changchun 130021 ,China
Corresponding author: LIU Ya-hui, E-mail：liuyahui2008@yeah.net
Abstract    Objective    To explore the value of "priority approach of uncinate process" in laparoscopic pancreaticoduodenectomy. Methods    The data of 200 patients who underwent laparoscopic pancreaticoduodenectomy in the No.2 Department of Hepatobiliarypancreatic Surgery, the First Hospital of Jilin University from April 2015 to October 2018 were analyzed retrospectively. Results    All the 200 patients successfully completed laparoscopic pancreaticoduodenectomy，including 1 case of laparoscopic pancreaticoduodenectomy combined with right hemicolectomy，2 cases of laparoscopic pancreaticoduodenectomy combined with pancreaticocotailectomy，and 2 cases of laparoscopic pancreaticoduodenectomy combined with portal vein reconstruction（end-to-end anastomosis）. The mean operation time was （281±49） min，including the specimen removal time（91±15） min，and the intraoperative blood loss was 50-850 mL（122±53） mL. The mean postoperative hospital stay was（16±9）days. Eight-teen cases（9.0%）had grade B pancreatic fistula and 3 cases（1.5%）had grade C pancreatic fistula. Postoperative anastomotic bleeding in 2 cases（1.0%）. Intraperitoneal hemorrhage was found in 14 cases（7.0%）, and delayed gastric emptying in 9 cases（4.5%）. Biliary fistula was found in 11 cases（5.5%）. There were 2 deaths（1.0%）. Postoperative pathological diagnosis showed that ductal adenocarcinoma of the head of pancreas was in 33 cases（16.5%），the pancreas intraductal papillary mucinous tumor in 15 cases（7.5%）， head of the pancreatic neuroendocrine tumors in 6 cases（3.0%），pancreatic ductal epithelial hyperplasia in 1 case（0.5%），solid pancreatic head fake papilloma in 9 cases（4.5%），pancreatic head capsule adenomas in 5 cases（2.5%），chronic pancreatitis in 1 case（0.5%），duodenal adenocarcinoma in 4 cases（2.0%）, duodenal stromal tumor in 2 cases（1.0%）, duodenal benign space-occupying lesions in 11 cases（5.5%），periampullary carcinoma of non pancreatic head origin in 105 cases（52.5%）and benign periampullary tumors in 9 cases（4.5%）. Conclusion    "Priority approach of uncinate process" is safe，rapid and effective in laparoscopic pancreaticoduodenectomy，which is worthy of further promotion and application in clinic.

Key words: pancreaticoduodenectomy, laparoscopic technique, surgical approach