Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors
Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors
复制标题
腹腔镜保留十二指肠全胰头切除术：治疗良性或低度恶性肿瘤的一种新手术方法
DOI：
10.1007/s00464-018-6488-2
复制
发表时间：
2019-02-01
影响因子：
3.1
通讯作者：
Min, Jun
中科院分区：
文献类型：
--
作者：
Cao, Jun;Li, Guo-lin;Min, Jun
背景保留十二指肠全胰头切除术(DPPHRt)是目前公认的治疗胰头良性或低度恶性肿瘤的另一种手术方式，其方法是保留十二指肠与十二指肠动脉弓的血供。本研究描述了我们在腹腔镜DPPHRt(LDPPHRt)手术中的经验。方法选择2016年8月至2017年5月在广州市中山大学附属中山纪念医院附属中山大学附属中山医院胰腺外科接受低密度脂蛋白高分辨率胰腺切除术的患者为研究对象，进行回顾性研究。年龄8~61岁，平均37.3岁。术前CT/MR显示胰头病变直径2~4.8 cm，平均3.7 cm。所有LDPPHRt手术均顺利完成。无围手术期死亡。手术时间210~320分钟，平均272.5分钟。术中出血量50~450亿毫升，平均215毫升。术后并发症包括B级胰瘘2例(16.7%)和胆漏2例(16.7%)。所有并发症对保守治疗反应良好。术后平均住院11.5d(6~25.0d)。结论LDPPHRt为胰头部良、低度恶性肿瘤提供了一种微创手术入路，保留了较好的器官。肿瘤的远期转归，以及手术后的胰腺外分泌和内分泌功能有待进一步研究。
BackgroundDuodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation.MethodsFrom August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study.ResultsThere were ten women and two men. The average age was 37.3 years (range 8–61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2–4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210–320 min). The average blood loss was 215 ml (range 50–450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6–25 days).ConclusionsLDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.