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目的探讨腹腔镜胰十二指肠切除术治疗胰头恶性肿瘤的可行性。方法我科2006年12月28日完成1例手助腹腔镜保留幽门胰十二指肠切除术。术中应用超声刀游离胰腺及其周围组织,钛夹夹闭重要血管,橡皮带牵引胰腺颈部,超声刀切断胰腺,分别在体内完成胰肠、胆肠吻合,体外完成胃肠吻合。结果本例手术顺利,手术时间600min,术中出血量300ml。病理为胰头恶性胰岛细胞瘤。术后3d恢复肠道功能,但出现胃排空延迟,对症支持14d后症状缓解,进食无不适。术后23d出院。随访19个月肿瘤无复发或转移。结论拥有熟练腹腔镜手术技能及胰腺手术专业知识的医生实施腹腔镜胰十二指肠切除术治疗经过选择的胰头恶性病例可行、安全,但必须严格把握手术适应证以及遵循肿瘤根治原则,手助腹腔镜技术以及悬吊断胰法能保证胰腺钩突部位的完全切除和足够的手术切缘。
Objective To investigate the feasibility of laparoscopic pancreatoduodenectomy in the treatment of pancreatic cancer. Methods December 28, 2006 our department completed a hand-assisted laparoscopic pylorus-retained pancreaticoduodenectomy. Intraoperative use of ultrasonic knife free pancreas and its surrounding tissue, titanium clips clamp important blood vessels, rubber bands traction pancreas neck, scalpel cut off the pancreas, respectively, in the body to complete the pancreas, cholangioenterostomy, gastrointestinal anastomosis completed in vitro. Results The operation was successful in this case. The operation time was 600 minutes and the intraoperative blood loss was 300ml. The pathology is pancreatic head islet cell tumor. Recovery of intestinal function after 3d, but delayed gastric emptying, symptomatic support 14d after symptom relief, eating no discomfort. 23d after discharge. No tumor recurrence or metastasis was observed after 19 months of follow-up. Conclusions Physicians with proficiency in laparoscopic surgery and expertise in pancreatic surgery may be feasible and safe in the treatment of selected pancreatic malignant cases with laparoscopic pancreaticoduodenectomy. However, strict indications of surgical indications and follow-up of radical tumor rule Laparoscopic laparoscopy and hanging off the pancreas method can ensure the complete removal of the uncinate site and adequate surgical margins.