中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (02): 199-204.DOI: 10.19538/j.cjps.issn1005-2208.2024.02.17

• 论著 • 上一篇    下一篇

完全腹腔镜胰十二指肠切除术及全胰切除术联合门静脉-肠系膜上静脉切除重建可行性及安全性分析

孙蒙清，陈少博，洪夏飞，董良博，何小东，韩显林   

  1. 中国医学科学院北京协和医院基本外科，北京100005
  • 出版日期:2024-02-01 发布日期:2024-02-23

  • Online:2024-02-01 Published:2024-02-23

摘要： 目的    探讨完全腹腔镜胰十二指肠切除术（LPD）及腹腔镜全胰切除术（LTP）联合门静脉-肠系膜上静脉（PV-SMV）切除重建的技术要点，及其安全性、可行性和根治性。方法    回顾性分析2022年5月至2023年9月在中国医学科学院北京协和医院接受LPD及LTP联合PV-SMV切除重建手术的13例病人临床资料。结果    13例病人中，10例病人行LPD，3例病人行LTP。7例（53.8%）病人行PV-SMV侧壁切除缝合，4例（30.8%）病人行PV-SMV节段切除、对端吻合，2例（15.4%）病人行PV-SMV节段切除、人工血管搭桥。手术时间（314.2±70.5）min。术中出血量（442.3±247.4）mL。PV-SMV中位阻断时间22（8～80）min。术后1例病人发生胃排空延迟，未发生B级以上胰瘘、术后出血、腹腔感染、胆瘘、二次手术、急性血栓栓塞事件及30 d内围手术期死亡。术后住院时间（10.7±4.7）d。术后病理学检查结果显示：1例为胰腺伴有破骨巨细胞的未分化癌，12例为胰腺导管腺癌。标本肿瘤大小（3.9±1.6）cm。术中淋巴结清扫（25.7±12.7）枚。淋巴结转移9例（69.2%）。术后病理学检查证实侵犯门静脉者5例（38.5%）。所有病人均为R0切除。术后门静脉通畅率100.0%。结论    对于经验丰富的微创胰腺手术团队，在合理选择适应证的基础上，LPD或LTP联合PV-SMV切除重建用于部分胰头癌侵犯PV-SMV的病人是安全可行的，可提高肿瘤的R0切除率，使病人获益。

关键词: 腹腔镜胰十二指肠切除术, 腹腔镜全胰切除术, 胰腺癌, 门静脉-肠系膜上静脉切除重建

Abstract: Feasibility and safety analysis of laparoscopic pancreaticoduodenectomy and total pancreatectomy  combined with portal vein-superior mesenteric vein resection and reconstruction        SUN Meng-qing, CHEN Shao-bo, HONG Xia-fei, et al.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing100005, China
Corresponding author: HAN Xian-lin, E-mail: hanxianlin@pumch.cn
Abstract    Objective    To analyze technical highlights, safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic total pancreatectomy (LTP) combined with portal vein-superior mesenteric vein (PV-SMV) resection and reconstruction. Methods    The clinical data of 13 patients who underwent LPD and LTP  combined with PV-SMV resection and reconstruction in Peking Union Medical College Hospital from May 2022 to September 2023 were retrospectivly analyzed. Results    Among the 13 patients, 10 underwent LPD, and 3 underwent LTP. Seven patients（53.8%） underwent PV-SMV sidewall resection and closure, 4 patients（30.8%） underwent PV-SMV segmental resection with end-to-end anastomosis, and 2 patients（15.4%） underwent PV-SMV segmental resection with artificial vascular bridging. The mean operative time was (314.2±70.5) minutes, with intraoperative blood loss of (442.3±247.4) mL. The median PV-SMV occlusion time was 22（8-80）minutes. One patient experienced delayed gastric emptying postoperatively. There was no occurrences of grade B or higher pancreatic fistula, postoperative bleeding, intra-abdominal infection, bile leakage, reoperation, acute thromboembolic events, or perioperative death within 30 days in this study. The mean postoperative hospital stay was (10.7±4.7) days. Pathological examination revealed one case of undifferentiated carcinoma with giant cells in the pancreas and 12 cases of pancreatic ductal adenocarcinoma. The mean tumor size was (3.9±1.6) cm. Intraoperatively, (25.7±12.7) lymph nodes were dissected, with lymph node metastasis observed in 9 cases (69.2%). Postoperative pathological examination confirmed portal vein invasion in 5 cases (38.5%). All patients achieved R0 resection. Postoperative portal vein patency rate was 100.0%. Conclusion    For experienced minimally invasive pancreatic surgery teams, LPD or LTP combined with PV-SMV resection and reconstruction is safe and feasible for patients with PV-SMV involvement in selected cases of pancreatic head cancer, improving the R0 resection rate and benefiting the patients.

Key words: laparoscopic pancreaticoduodenectomy, laparoscopic total pancreatectomy, pancreatic cancer, portal vein-superior mesenteric vein resection and reconstruction.