摘要
目的探讨微创保留十二指肠的胰头切除术(DPPHR)治疗胰头良性和交界性肿瘤的临床效果。方法回顾性分析2015年10月至2021年9月于浙江省人民医院胃肠胰外科因胰头良性或交界性肿瘤行腹腔镜或机器人DPPHR的33例患者资料。男性10例,女性23例,年龄[M(IQR)]54(32)岁(范围:11~77岁),体重指数21.9(2.9)kg/m^(2)(范围:18.1~30.1 kg/m^(2))。临床症状:腹痛12例,Whipple三联征2例,无症状因体检发现19例。合并高血压7例,糖尿病1例。美国麻醉医师协会评分:Ⅰ级19例,Ⅱ级14例。定量资料的组间比较采用Student t检验或U检验;分类资料的组间比较采用χ^(2)检验或Fisher确切概率法。结果33例患者中,14例行腹腔镜DPPHR,19例行机器人DPPHR。重建方式:胰胃吻合5例,胰肠吻合28例。术后病理学检查结果显示,导管内乳头状黏液腺瘤9例,实性假乳头状瘤9例,浆液性囊腺瘤7例,神经内分泌瘤6例,黏液性囊腺瘤1例,慢性胰腺炎1例。手术时间(309.4±50.3)min(范围:180~420 min),术中出血量(97.9±48.3)ml(范围:20~200 ml)。围手术期出现并发症18例,其中3例出现严重并发症(Clavien-Dindo并发症分级≥Ⅲ级)。发生胰瘘16例,其中生化漏8例,B级胰瘘7例,C级胰瘘1例。无围手术期死亡病例。术后住院14(7)d(范围:6~87 d)。术后随访22.6(24.5)个月(范围:2~74个月),未见肿瘤复发,2例出现脂肪泻伴体重下降,1例于术后12个月并发非酒精性脂肪性肝病,无术后新发糖尿病。所有患者术后均未出现胆道狭窄及反流性胆管炎。结论微创DPPHR治疗胰头良性和交界性肿瘤是可行的,可保留更多的胰腺内外分泌功能,避免胆道并发症。
Objective To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR)for benign and pre-malignant lesions of pancreatic head.Methods The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People′s Hospital.Thirty-three patients were enrolled with 10 males and 23 females.The age(M(IQR))was 54(32)years old(range:11 to 77 years old)and the body mass index was 21.9(2.9)kg/m^(2)(range:18.1 to 30.1 kg/m^(2)).The presenting symptoms included abdominal pain(n=12),Whipple triad(n=2),and asymptomatic(n=19).There were 7 patients with hypertension and 1 patient with diabetes mellitus.There were 19 patients who were diagnosed as American Society of Anesthesiologists classⅠand 14 patients who were diagnosed as classⅡ.The student t test,U test,χ^(2) test or Fisher exact test was used to compare continuous data or categorized data,respectively.All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded.Results Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR.Indocyanine green fluorescence imaging was used in 19 patients to guide operation.Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy.Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms,9 intraductal papillary mucinous neoplasms,7 serous cystic neoplasms,6 pancreatic neuroendocrine tumors,1 mucous cystic neoplasm,1 chronic pancreatitis.The operative time was(309.4±50.3)minutes(range:180 to 420 minutes),and the blood loss was(97.9±48.3)ml(range:20 to 200 ml).Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade�
作者
鲁超
金巍巍
牟一平
周育成
王元宇
夏涛
朱启聪
徐必武
任宇峰
孟思嘉
何钰辉
蒋启涛
Lu Chao;Jin Weiwei;Mou Yiping;Zhou Yucheng;Wang Yuanyu;Xia Tao;Zhu Qicong;Xu Biwu;Ren Yufeng;Meng Sijia;He Yuhui;Jiang Qitao(Department of General Surgery,Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital(People′s Hospital of Hangzhou Medical College),Key Laboratory of Gastroenterology of Zhejiang Province,Hangzhou 310014,China;Bengbu Medical College,Bengbu 233030,China;Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2022年第1期39-45,共7页
Chinese Journal of Surgery
基金
浙江省科技厅“尖兵”领雁研发公关计划(2021C03G1124340)
浙江省医药卫生临床研究应用项目(2022KY038)
浙江省医学会临床科研基金(2021ZYC-A53)
浙江省自然科学基金(LGF20H160011)
浙江省人民医院优秀科研启动基金(ZRY2021C014)。
关键词
胰腺肿瘤
外科手术
保留十二指肠的胰头切除术
功能保留
腹腔镜
机器人
Pancreatic neoplasms
Surgical procedures,operative
Duodenum preserving pancreatic head resection
Function preserving
Laparoscopic
Robotic
