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开放胰十二指肠切除术(OPD)仍然是治疗胰头部及壶腹部周围病变的标准术式,其术后病死率已经明显降低,但并发症发生率仍很高,其中包括切口感染等切口相关并发症。腹腔镜和机器人胰十二指肠切除术(LPD和RPD)视野清晰、出血少,具有明显的微创优势。经过严格训练,并选择合适的病例,LPD和RPD均安全可行,可获得与OPD相近的肿瘤治疗近期和远期效果。LPD目前已可成为常规术式。机器人手术系统设备昂贵,缺乏力反馈,技术要求高,但操作更精细,缝合较腹腔镜手术更有优势,更适合用于胰管、胆管直径细小的病例。腹腔镜手术切除标本后再使用机器人手术系统进行消化道重建的杂交手术有一定现实意义。建立由同时掌握开放、腹腔镜及机器人手术技术的外科医生为主导,影像科、消化内科、肿瘤内科和病理科等医生共同参与的多学科综合治疗协作组(MDT)模式,是合理选择开放、腹腔镜和机器人胰十二指肠切除术的关键。
Open pancreatoduodenectomy (OPD) is still the standard procedure for the treatment of lesions around the head and ampulla, and its postoperative mortality has been significantly reduced, but the incidence of complications is still high, including incisional infection Incision-related complications. Laparoscopic and robot pancreatoduodenectomy (LPD and RPD) clear vision, less bleeding, with obvious advantages of minimally invasive. After rigorous training, and select the appropriate case, LPD and RPD are safe and feasible, available with OPD similar tumor treatment of short and long term effects. LPD is now a routine procedure. Robot surgical system equipment expensive, lack of force feedback, high technical requirements, but the operation is more sophisticated, suture laparoscopic surgery more advantages, more suitable for pancreatic duct, small bile duct diameter cases. Laparoscopic resection of the specimen and then use the robotic surgery system for hybridization of the digestive tract reconstruction has some practical significance. Establishing MDT models led by surgeons who also have open, laparoscopic and robotic surgical techniques and who are involved in imaging, gastroenterology, oncology and pathology is a logical way to choose an open, Laparoscopic and robotic pancreatoduodenectomy is the key.