中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

胰腺全系膜切除用于腹腔镜胰头癌根治术34例疗效分析

张建生，王天阳，刘润田，王文斌，闫长青，吕海涛，刘学青，李秋生，李冬瑞，邢中强，路文彦，刘建华   

  1. 河北医科大学第二医院，河北石家庄 050000
  • 出版日期:2017-04-01 发布日期:2017-03-31

  • Online:2017-04-01 Published:2017-03-31

摘要：

目的    探讨胰腺全系膜切除（TMpE）用于腹腔镜胰头癌根治术的可行性及有效性。方法    回顾性分析2014年11月至2017年1月河北医科大学第二医院肝胆外科行腹腔镜胰十二指肠切除术34例胰头癌病人的临床资料，均应用动脉先行技术实施TMpE。随访观察并发症发生情况及术后存活情况。结果    34例病人均实施全腹腔镜手术，手术时间为（468.7±78.2）min，术中出血（748.5±256.5）mL。术后13例发生并发症，其中5例发生胰瘘，无围手术期死亡病例。清扫淋巴结数目为7~25（14.6±3.8）枚，其中23例存在淋巴结转移，其数目为1~8（2.7±1.1）枚。34例中28例（82.4%）达到R0切除。截至2017-01-30，随访8（1～25）个月，7例病人死亡，其中1例术后2个月因肺部感染死亡，另6例均因肿瘤复发死亡，术后生存期为11（5～14）个月，余27例存活病人仍在随访中。结论    TMpE用于腹腔镜胰头癌根治术安全可行，有助于提高R0切除率。

关键词: 胰头癌, 腹腔镜, 胰十二指肠切除术, 胰腺系膜, 胰腺全系膜切除

Abstract:

Total mesopancreas excision in laparoscopic pancreaticoduodenectomy for the treatment of pancreatic head carcinoma: An analysis of 34 patients        ZHANG Jian-sheng，WANG Tian-yang，LIU Run-tian，et al. The Second Hospital of Hebei Medical University，Shijiazhuang 050000，China
Corresponding author：ZHANG Jian-sheng，E-mail: 15130119600@163.com
Abstract    Objective    To evaluate the feasibility and clinical efficacy of total mesopancreas excision (TMpE) in laparoscopic pancreaticoduodenectomy (LPD) of pancreatic head carcinoma. Methods    From November 2014 to January 2017，34 patients of pancreatic head carcinoma applied artery priority TMpE during the LPD in Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University. The clinical and pathological data were analyzed retrospectively, and the complications and postoperative survival were observed and followed up. Results    All 34 patients underwent complete laparoscopic surgery. The mean operation time was 468.7±78.2 min and the mean blood loss was 748.5±256.5 mL. Postoperative complications were reported in 13 patients，including 5 cases of pancreatic fistula，and no perioperative death was noted. The pathological examination showed that 7~25(14.6±3.8) lymph nodes were dissected, including 1~8(2.7±1.1) with metastasis in 23 cases. Of all the 34 cases, R0 resection was achieved in 28 cases (82.4%). After 8(1～25) months' follow-up, by January 30, 2017，7 cases were dead, with the postoperative survival of 11(5～14) months，including 1 case dead of pulmonary infection 2 months after operation and the other 6 cases dead of tumor recurrence. The other 27 cases are still in follow-up. Conclusion    TMpE is feasible and safe for pancreatic head carcinoma in the LPD and is helpful to increase the R0 resection rate.

Key words: pancreatic head carcinoma, laparoscopy, pancreaticoduodenectomy, mesopancreas, total mesopancreas excision