摘要
目的探讨全腹腔镜胰十二指肠切除术(total laparoscopic pancreaticoduodenectomy,TLPD)的安全性及短期临床疗效。方法2015年12月至~2017年12月对102例胰管直径≥3mm恶性肿瘤行TLPD,术中完成标本整块切除后按照Child顺序进行腔镜下消化道重建,胰肠吻合采用胰管对空肠黏膜吻合。结果102例顺利完成TLPD。手术时间(427±159)min,术中出血量(294±107)ml,胰肠吻合时间为(36.1±14.7)min,淋巴结清扫数目(15.2±5.7)枚,R0切除率94.1%(96/102),术后进食流质饮食时间(5.5±2.6)d,术后ICU入住时间(3.5±2.3)d,术后住院时间(10.9±5.9)d。术后并发症发生率37.3%(38/102),其中A级胰漏发生率19.6%(20/102),B或C级胰漏发生率10.8%(11/102)。100例随访(11.4±4.7)月,术后6个月无瘤生存率90.0%(90/100),因肿瘤复发转移导致死亡13例(术后6~12个月死亡3例,13~24个月死亡8例,25~30个月死亡2例),肿瘤外因素死亡3例。结论对胰管直径≥3mm恶性肿瘤患者施行TLPD安全可靠,短期疗效满意。
Objective To investigate the safety and short-term clinical efficacy of total laparoscopic pancreaticoduodenectomy( TLPD). Methods TLPD was performed in 102 patients with malignant tumor with pancreatic duct diameter more than 3 mm from December 2015 to December 2017. During the operation,the surgical specimens were removed completely,and the digestive tract was reconstructed under the Child sequence. The patients received duct-to-mucosa pancreaticojejunostomy. Results All the TLPD operations were successfully completed. The operation time was( 427 ± 159) min,the amount of intraoperative bleeding was( 294 ±107) ml,the time of pancreaticojejunostomy was( 36. 1 ± 14. 7) min,the number of lymph node dissected was( 15. 2 ± 5. 7),the R0 resection rate was 94. 1%( 96/102),the liquid diet time postoperatively was( 5. 5 ± 2. 6) d,the postoperative ICU stay time was( 3. 5 ± 2. 3) d,and the postoperative hospitalization time was( 10. 9 ± 5. 9) d. The incidence of postoperative complications was37. 3%( 38/102),including an incidence of grade A pancreatic leakage of 19. 6%( 20/102) and an incidence of grade B or C pancreatic leakage of 10. 8%( 11/102). A total of 100 patients were followed up for( 11. 4 ± 4. 7) months. The 6-month tumor free survival rate was 90. 0%( 90/100). Thirteen deaths were caused by recurrence and metastasis of tumors( 3 died 6-12 months after operation,8 died 13-24 months,2 died 25-30 months),and 3 died of other reasons. Conclusion TLPD is safe and effective for patients with malignant tumor with pancreatic duct diameter greater than 3 mm,and its short-term effect is satisfactory.
作者
柴伟
雷豹
孟宇
赵秀雷
张雷
孔德帅
刘汝海
Chai Wei;Lei Bao;Meng Yu(Department of General Surgery,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第6期490-493,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜胰十二指肠切除术
胰肠吻合
胰漏
Laparoscopic pancreaticoduodenectomy
Pancreaticojejunostomy
Pancreatic leakage
