| 王有龙,张 宝,张 希.“四孔法”腹腔镜胰十二指肠切除术的临床经验总结[J].肿瘤学杂志,2015,21(10):804-809. |
| “四孔法”腹腔镜胰十二指肠切除术的临床经验总结 |
| The Surgical Experience of Laparoscopic Pancreaticoduodenectomy via a Reverse- “V” Approach with Four Ports |
| 投稿时间：2015-03-16 |
| DOI：10.11735/j.issn.1671-170X.2015.10.B005 |
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| 中文关键词: 腹腔镜胰十二指肠切除术 开腹手术 |
| 英文关键词:laparoscopic pancreaticoduodenectomy operation,indications |
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| 中文摘要: |
| 摘 要：［目的］ 评估反“V”路径四孔腹腔镜胰十二指肠切除（LPD）的可行性、安全性和有效性。［方法］ 回顾性研究施行腹腔镜胰十二指肠切除术的32例病例，包括肝切除联合胰十二指肠切除术2例，并对所筛选病例的病例特点、组织学特点、术后并发症等方面进行系统的总结分析。［结果］ LPD可适用于胰腺导管细胞癌（9例）、导管内乳头状黏液性肿瘤（2例）、壶腹癌（7例）、胆管下端癌（4例）、肝门胆管癌（2例）、实性假乳头状瘤（2例）、囊腺瘤（3例）、慢性胰腺炎（1例）、肝内胆管癌胰头转移（1例）、胆囊管癌浸润十二指肠（1例）患者。患者平均年龄为65岁（42~80岁），平均手术时间为 386min(260~510min)，术中平均出血量340ml(30~1600ml)，术后平均住院时间 14天(10~21天)，术后死亡率为0。［结论］ 反“V”路径四孔腹腔镜胰十二指肠切除术是安全有效的，可适用于临床某些特定病例。对于局部恶性病变的患者，不论病理学如何，这种方法均适用。初步的临床经验表明，反“V”路径腹腔镜胰十二指肠切除术具有良好的应用前景，甚至可适用于肝切除联合胰十二指肠切除术。 |
| 英文摘要: |
| Abstract：［Purpose］ To simplify its surgical procedure of laparoscopic pancreaticoduodenectomy (LPD) and improve its efficacy，we performed LPD via reverse -“V” approach with four ports. The present series aimed to evaluate the feasibility，safety and efficacy of the modified LPD. ［Methods］ This was a retrospective study of selected patients who underwent laparoscopic pancreaticoduodenectomy. We described the salient features of technique and follow-up protocol. Patient characteristics，histologic variety of the tumor，operative outcome，resection margins，morbidity，mortality were reviewed. ［Results］ The procedure could be completed laparoscopically with tumor-free margins in all patients，including patients with pancreatic ductal adenocarcinoma(6 cases)，ampullary carcinoma (6 cases)，intraductal papillary mucinous neoplasm(2 cases)，pancreatic cystadenocarcinoma (2 cases)，pancreatic head adenocarcinoma (3 cases) and bile duct cancer (2 cases). Mean age of patients was 65 years (range，42~75 years). Median operative time and blood loss and 340ml (range，30~1600ml). The mean operating time was 386min(range，260~510min). There was no perioperative mortality. ［Conclusions］ Laparoscopic pancreaticoduodenectomy via reverse -“V” approach can be performed with safety and good results in properly selected patients. Localized malignant lesions，irrespective of histopathology are particularly amenable to this approach. The preliminary experience shows a good prospect via reverse -“V” approach for LDP. |
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