腹腔镜十二指肠乳头肿瘤局部切除术(附六例报告)

目的探讨腹腔镜十二指肠乳头肿瘤局部切除术(laparoscopic transduodenal pullectomy, LTDP)的安全性及可行性。 方法回顾性分析滨州医学院附属医院于2020年3月至2021年1月期间，6例行LTDP患者的临床资料、手术过程、围手术期处理措施和随访信息。 结果6例患者平均手术时间342.2 min，平均术中出血量约46.7 ml，平均术后恢复经口进食流质饮食时间约4.2 d，平均术后排气时间49.3 h，平均术后住院时间12 d。术后病理：1例十二指肠乳头黏液腺癌、2例十二指肠乳头管状-绒毛状腺瘤、3例十二指肠乳头腺癌，切缘均为阴性。6例患者均无围手术期死亡，1例患者术后出现十二指肠出血，其余患者无并发症发生。平均术后随访时间19.6个月(16~25个月)，1例十二指肠乳头腺癌患者术后20个月肿瘤局部复发行姑息性手术治疗，其余患者目前无肿瘤复发。 结论LTDP应用于十二指肠良性肿瘤、交界性肿瘤、十二指肠乳头腺瘤局部癌变、十二指肠乳头原位癌、无淋巴结转移的T1期肿瘤、高龄且合并较多基础疾病的不能耐受胰十二指肠切除的十二指肠乳头癌患者是安全、可行的。

Laparoscopy transduodenal papillectomy of papillary tumor: a report of 6 cases

ObjectiveTo investigate the safety and feasibility of laparoscopic transduodenal pullectomy (LTDP) of papillary tumor. MethodsThe clinicopathological data, surgical procedures, perioperative treatment measures and follow-up information of six LTDP patients from Mar. 2020 to Jan. 2021 in the Binzhou Medical University Hospital were retrospectively analyzed. ResultsThe average operation time of six patients was 342.2 min, the average intraoperative bleeding volume was about 46.7 ml. The average time of trans-oral fluid diet was about 4.2 d, the average exhaust time was 49.3 h, and the average postoperative hospital stay was 12 d. Postoperative pathology: 1 case of duodenal papillary mucinous adenocarcinoma, 2 cases of duodenal papillary tubular-villous adenoma, and 3 cases of duodenal papillary adenocarcinoma, all with negative margins. There were no perioperative deaths in six patients, one patient had postoperative duodenal hemorrhage, and the rest had no complications.The average postoperative follow-up was 19.6 months (16-25 months), and one patient with duodenal papillary adenocarcinoma had local tumor recurrence at 20 months and underwent palliative surgical treatment; the remaining patients had no tumor recurrence. ConclusionsLTDP is safe and feasible in patients with benign duodenal papillary tumors borderline tumors, duodenal papilladenoma, duodenal papillary carcinoma in situ, stage T1 tumors without lymph node metastasis, and duodenal papillary malignant tumors at advanced age and with underlying diseases.