中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (05): 575-579.DOI: 10.19538/j.cjps.issn1005-2208.2022.05.19

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应用中间入路行腹腔镜胰十二指肠切除术临床研究

马明剑，程    合，陈榆升，刘    辰   

  1. 复旦大学附属肿瘤医院胰腺外科  复旦大学上海医学院肿瘤学系  上海市胰腺肿瘤研究所  复旦大学胰腺肿瘤研究所，上海 200032
  • 出版日期:2022-05-01 发布日期:2022-05-17

  • Online:2022-05-01 Published:2022-05-17

摘要： 目的    探讨中间入路腹腔镜胰十二指肠切除术（LPD）对术区淋巴结清扫的影响。方法    回顾性分析2021年1月至2022年1月在复旦大学附属肿瘤医院胰腺外科采用中间入路LPD（27例）及传统入路LPD（25例）病人临床资料。对比两组病人术中情况、病理学检查结果和并发症发生率。结果    两组病人各有1例中转开放手术，均未发生围手术期死亡。中间入路组和传统入路组术后总并发症、B级胰瘘和腹腔感染发生率差异无统计学意义，均未发生C级胰瘘、胆漏和出血。中间入路组淋巴结清扫数［（22±8）枚 vs.（17±7）枚，P=0.029］、阳性淋巴结数目［（6±2）枚 vs. （3±2）枚，P=0.001］更多，淋巴结阳性率也更高［（0.36±0.04）vs.（0.16±0.03），P＜0.001］。两组淋巴结转移率（48.1% vs. 44.0%，P=0.974）差异无统计学意义。结论    中间入路LPD较传统入路LPD安全、可行，且前者术区淋巴结清扫更彻底。

关键词: 胰十二指肠切除术, 腹腔镜, 胰腺钩突, 中间入路, 传统入路

Abstract: Research of the application of intermediate approach in laparoscopic pancreaticoduodenectomy        MA Ming-jian, CHENG He, CHEN Yu-sheng, et al. Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Pancreatic Cancer Institute, Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China
Corresponding author：LIU Chen, E-mail: liuchen@fudanpci.org
Abstract    Objective    To investigate the effect of intermediate approach laparoscopic pancreatic duodenal resection (LPD) on lymph node dissection. Methods    Clinical data of patients who underwent LPD with intermediate approach (IA group, 27 patients) or traditional approach (TA group, 25 patients) management of the pancreatic uncinate process in Fudan University Shanghai Cancer Center between January 2021 and January 2022 were retrospectively analyzed, comparing and analyzing the intraoperative conditions, pathological results and complication rates between two groups. Results    One patient in each group was transferred to laparotomy, and no perioperative death occurred in all patients. There were no statistically significant differences in the incidence of total postoperative complications, grade B pancreatic fistula, and intraperitoneal infection in both groups. Neither group developed grade C pancreatic fistula, biliary leakage, or bleeding. The number of dissected lymph nodes (22±8 vs. 17±7, P=0.029) and positive lymph nodes (6±2 vs. 3±2, P=0.001) was higher in the IA group. Also, the positive lymph node ratio (0.36±0.04 vs. 0.16±0.03, P<0.001) was higher in the IA group. There were no significant differences in lymph node metastasis rate (44.8% vs. 44.0%, P=0.974) between the two. Conclusion    Management of pancreatic uncinate process via intermediate approach is safe and feasible for LPD. Besides, it dissects lymph nodes more thoroughly than the traditional approach.

Key words: pancreaticoduodenectomy, laparoscopes, pancreatic uncinate process, intermediate approach, traditional approach