3D腹腔镜胰十二指肠切除在壶腹周围癌治疗中的应用:单团队经验

发布时间：2018-03-11 13:15

本文选题：胰十二指肠切除术　切入点：腹腔镜　出处：《中国普通外科杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的:总结3D腹腔镜胰十二指肠切除治疗壶腹周围癌的经验与临床疗效。方法:回顾性分析2014年1月—2017年3月101例在湖南省人民医院肝胆外科行3D腹腔镜胰十二指肠切除术的壶腹周围癌101例患者的临床资料。结果:全组平均手术时间为325.7(220~575)min,术中出血为175.9(100~550)mL。术后并发症包括胰瘘23例(22.8%),其中生化瘘17例(16.8%)、B级胰瘘5例(5.0%)、C级胰瘘1例(1.0%),术后出血7例(6.9%),术后胆汁漏2例(3.0%),胃排空延迟4例(4.0%),腹腔感染6例(5.9%),肺部感染3例(3.0%),肠梗阻2例(2.0%);Clavien并发症分级III级以上患者9例(8.9%),其中3例患者行再次手术;住院30 d内死亡患者1例(1.0%);术后平均住院时间14.8(8~29)d;术后病理为胆总管下端癌27例(26.7%)、壶腹部癌23例(22.8%)、十二指肠乳头癌39例(38.6%)、胰腺导管腺癌12例(11.9%),肿瘤直径(2.3±1.3)cm,R_0切除率95.0%,淋巴结清扫数目为(16.7±4.2)枚,其中阳性淋巴结为(1.3±1.1)枚。结论:3D腹腔镜胰十二指肠切除治疗壶腹周围癌安全可行,近期疗效良好。
[Abstract]:Objective: to summarize the experience and clinical effect of 3D laparoscopic pancreaticoduodenectomy in the treatment of periampullary carcinoma. Methods: from January 2014 to March 2017, 101 cases of hepatobiliary surgery in Hunan Provincial people's Hospital were treated with 3D laparoscopic pancreatic 12. Clinical data of 101 patients with periampullary carcinoma after digital enterectomy. Results: the average operative time was 325.720 ~ 575 min, and the intraoperative bleeding was 175.9 ~ 100 ~ 550ml 路mL ~ (-1). Postoperative complications included pancreatic fistula (n = 23) and pancreatic fistula (n = 22. 8). Among them, 17 cases were biochemical fistula (n = 17), 5 cases (n = 5) with grade B pancreatic fistula (n = 5) and 5 cases (n = 5.0) with grade C pancreatic fistula (n = 5). There were 7 cases of postoperative hemorrhage, 2 cases of bile leakage, 4 cases of delayed gastric emptying, 4 cases of gastric emptying, 6 cases of intraperitoneal infection, 3 cases of pulmonary infection, 9 cases of intestinal obstruction with III grade or above, 9 cases of intestinal obstruction, and 3 cases of reoperation. One patient died within 30 days of hospitalization. The average hospital stay was 14.8 ~ 829 days. Postoperative pathology included 27 cases with carcinoma of the lower common bile duct, 23 cases with ampullary carcinoma, 39 cases with duodenal papillary carcinoma, 39 cases with duodenal papillary carcinoma, 12 cases with pancreatic ductal adenocarcinoma, with tumor diameter 2.3 卤1.3 cm R0. The resection rate was 95.0%. The number of lymph node dissection was 16.7 卤4.2. The positive lymph nodes were 1.3 卤1.1. Conclusion 3% 3D laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma.
【作者单位】：湖南省人民医院肝胆外科;
【基金】：湖南省教育厅科学研究重点基金资助项目(16A127) 湖南省科技计划重点研发基金资助项目(2015sk2050)
【分类号】：R735.0

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