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目的探讨电视腹腔镜胰十二指肠切除术的可行性,手术难点及手术适应证。方法分析我院2002年11月22日～2005年4月28日电视腹腔镜胰十二指肠切除术5例的临床资料。分析术前诊断、手术主要方法、步骤、术中出血量、手术时间、术中难点及对策,术后恢复情况及有关指标包括:体温、引流量、血常规、肝功能、胰淀粉的酶变化及术后并发症,肠道功能恢复情况,住院时间等。结果5例手术均成功,手术时间360～660min,平均528min。术中出血150～2000ml,平均770ml。病理类型:十二指肠乳头高分化腺癌3例,胰头内分泌小细胞癌1例,十二指肠乳头腺瘤样增生恶变,肝胆管中上段中分化腺癌1例。术后例1出现小量胰漏;例2出现消化道应激性溃疡出血,均经对症处理治愈;例4术后出现复发性胰腺炎合并肺部感染,术后39d出现应激性溃疡消化道出血再次手术死亡,术后体温例4胰腺炎复发后体温高达39.5℃,其余4例最高体温<38℃,术后引流量除例4外其余4例最多者术后第一天800ml,逐渐减少至100ml,持续5d。全部病例术后3d左右均恢复肠鸣,1周恢复进食。结论腹腔镜下胰十二指肠切除术是目前腔镜外科最复杂的高风险手术,需要有丰富的传统胰十二指肠切除的临床经验,熟练的腔镜外科操作技术,配合默契的手术团队,先进的腔镜设备,严格的手术适应证,在具备条件的医院及医生中进行该手术是安全、可行的。目前可选择适当的病例进行临床探讨。
Objective To investigate the feasibility of laparoscopic pancreatoduodenectomy for television, surgical difficulties and surgical indications. Methods The clinical data of 5 cases of laparoscopic pancreatoduodenectomy in our hospital from November 22, 2002 to April 28, 2005 were analyzed. Analysis of preoperative diagnosis, major surgical methods, procedures, intraoperative blood loss, operation time, intraoperative difficulties and countermeasures, postoperative recovery and related indicators include: body temperature, drainage, blood, liver function, pancreatic starch enzyme changes And postoperative complications, intestinal function recovery, hospitalization time and so on. Results All the 5 cases were successful. The operation time was 360 ~ 660min with an average of 528min. Intraoperative bleeding 150 ~ 2000ml, an average of 770ml. Pathological type: 3 cases of duodenal papilla well-differentiated adenocarcinoma, 1 case of pancreatic endocrine small cell carcinoma, 1 case of duodenal papillary adenoma-like hyperplasia and 1 case of middle and high grade hepatocellular carcinoma. A small amount of pancreatic leakage occurred in case 1 after operation. Bleeding of digestive tract ulcer occurred in case 2, all of which were cured by symptomatic treatment. Case 4 recurrent pancreatitis complicated with pulmonary infection after operation and stress ulcer digestion Hemorrhage re-operation death, postoperative body temperature 4 pancreatitis recurrence temperature as high as 39.5 ℃, the remaining 4 cases of maximum body temperature <38 ℃, except for cases of drainage after 4 cases, the remaining 4 cases were the most 800ml on the first postoperative day, and gradually Reduce to 100ml for 5d. All cases were recovering bowel around 3d after surgery, 1 week to resume eating. Conclusions Laparoscopic pancreatoduodenectomy is the most complicated and high-risk endoscopic surgery. It requires rich clinical experiences of traditional pancreatoduodenectomy, skilled endoscopic surgical techniques and tacit surgery Team, advanced endoscopic equipment, strict surgical indications, in the conditions of hospitals and doctors in the surgery is safe and feasible. Now choose the appropriate case for clinical study.