腹腔镜胰十二指肠切除术经验初探

目的 探讨腹腔镜胰十二指肠切除术（LPD）初期应用的可行性和安全性。方法 回顾性分析2018 年8 月至2019 年8 月徐州医科大学附属宿迁医院收治的10 例行LPD治疗的壶腹周围癌及胰头部良性或恶性肿瘤患者术中及术后临床资料。所有患者均由同一组手术医师采用“五孔法”经典路径行LPD。结果 所有患者均顺利完成LPD手术。平均手术时间（437.0±87.0）min，术中出血量（171.0±106.0）mL，均未输血。总体并发症发生率为40%（4/10）。患者术后（2.0±1.1）d下床活动，术后住院时间（15.0±2.0）d。术后发生胰瘘3 例，其中A级2 例，B级1 例；上消化道出血1 例。术后中位随访时间9（2～14）个月，期间无患者死亡，1 例发现肿瘤复发转移。结论 LPD创伤小，安全有效，术后恢复快，并发症发生率在可接受范围内，具有一定优势。应用开展初期通过病例选择循序渐进，具备一定腹腔镜手术技术和经验的术者开展LPD是安全可行的。

Preliminary experience of laparoscopic pancreatoduodenectomy

Objective To investigate the feasibility and safety of laparoscopic pancreaticoduodenectomy (LPD) in the early stage. Methods The intraoperative and postoperative clinical data of 10 patients with periampullary cancer and benign or malignant tumors of the pancreas head who treated with LPD from Aug. 2018 to Aug. 2019 in the Affiliated Suqian Hospital of Xuzhou Medical University were retrospective analyzed. All the LPD operations were completed by the same surgery group with the classic route of “five-hole” method. ResultsThe patients all completed the LPD operation successfully. The operation time and the intraoperative blood loss were (437.0±87.0) min and (171.0±106.0) mL, respectively. No blood transfusion occurred during the operation. The overall postoperative complication rate was 40% (4/10). The time of postoperative out-of-bed activity was(2.0±1.1) d and the length of postoperative hospitalization was (15.0±2.0) d. The median follow-up time was 9(2 to14) months after operation, during which, no patient died, and one patient was found with tumor recurrence and distant metastasis. Conclusion LPD is less invasive, safe and effective, and patients can recover quickly after surgery. The incidence of postoperative complications was within acceptable range. It is safe and feasible for surgeons with certain laparoscopic surgery techniques and experience to carry out LPD in the early stages through case selection step by step.