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目的探讨胰腺全系膜切除(TMp E)用于腹腔镜胰头癌根治术的可行性及有效性。方法回顾性分析2014年11月至2017年1月河北医科大学第二医院肝胆外科行腹腔镜胰十二指肠切除术34例胰头癌病人的临床资料,均应用动脉先行技术实施TMp E。随访观察并发症发生情况及术后存活情况。结果 34例病人均实施全腹腔镜手术,手术时间为(468.7±78.2)min,术中出血(748.5±256.5)m L。术后13例发生并发症,其中5例发生胰瘘,无围手术期死亡病例。清扫淋巴结数目为7~25(14.6±3.8)枚,其中23例存在淋巴结转移,其数目为1~8(2.7±1.1)枚。34例中28例(82.4%)达到R0切除。截至2017-01-30,随访8(1~25)个月,7例病人死亡,其中1例术后2个月因肺部感染死亡,另6例均因肿瘤复发死亡,术后生存期为11(5~14)个月,余27例存活病人仍在随访中。结论 TMp E用于腹腔镜胰头癌根治术安全可行,有助于提高R0切除率。
Objective To investigate the feasibility and effectiveness of total mesorectal excision (TMp E) for radical mastectomy of pancreatic cancer of the pancreas. Methods The clinical data of 34 patients with pancreatic head cancer who underwent laparoscopic pancreatoduodenectomy from January 2014 to January 2017 in Hepatobiliary Surgery Department of the Second Hospital of Hebei Medical University were analyzed retrospectively. Follow-up observation complications and postoperative survival. Results All the 34 patients underwent total laparoscopic surgery. The operative time was (468.7 ± 78.2) min and the intraoperative bleeding was (748.5 ± 256.5) m L. Postoperative complications occurred in 13 cases, of which 5 cases of pancreatic fistula occurred, no perioperative deaths. The number of lymph nodes was 7 ~ 25 (14.6 ± 3.8), of which 23 had lymph node metastasis, the number of which was 1 ~ 8 (2.7 ± 1.1). Of the 34 cases, 28 (82.4%) achieved R0 resection. As of 2017-01-30, up to 8 months (1 ~ 25) months, 7 patients died. One patient died of pulmonary infection after 2 months and the other 6 patients died of tumor recurrence. The survival rate was 11 (5 ~ 14) months, more than 27 cases of surviving patients are still under follow-up. Conclusion TMp E for laparoscopic pancreatic cancer radical surgery is safe and feasible, to help improve R0 resection rate.