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[目的]评估反“V”路径四孔腹腔镜胰十二指肠切除(LPD)的可行性、安全性和有效性。[方法]回顾性研究施行腹腔镜胰十二指肠切除术的32例病例,包括肝切除联合胰十二指肠切除术2例,并对所筛选病例的病例特点、组织学特点、术后并发症等方面进行系统的总结分析。[结果]LPD可适用于胰腺导管细胞癌(9例)、导管内乳头状黏液性肿瘤(2例)、壶腹癌(7例)、胆管下端癌(4例)、肝门胆管癌(2例)、实性假乳头状瘤(2例)、囊腺瘤(3例)、慢性胰腺炎(1例)、肝内胆管癌胰头转移(1例)、胆囊管癌浸润十二指肠(1例)患者。患者平均年龄为65岁(42~80岁),平均手术时间为386min(260~510min),术中平均出血量340ml(30~1600ml),术后平均住院时间14天(10~21天),术后死亡率为0。[结论 ]反“V”路径四孔腹腔镜胰十二指肠切除术是安全有效的,可适用于临床某些特定病例。对于局部恶性病变的患者,不论病理学如何,这种方法均适用。初步的临床经验表明,反“V”路径腹腔镜胰十二指肠切除术具有良好的应用前景,甚至可适用于肝切除联合胰十二指肠切除术。
[Objective] To evaluate the feasibility, safety and efficacy of four-port laparoscopic pancreaticoduodenectomy (LPD) against the “V” path. [Methods] Thirty-two cases of laparoscopic pancreatoduodenectomy, including liver resection and pancreatoduodenectomy, were retrospectively studied. The case characteristics, histological features, Complications and other aspects of systematic analysis. [Results] LPD could be applied to pancreatic ductal cell carcinoma in 9 cases, ductal papillary mucinous neoplasm in 2 cases, ampullary carcinoma in 7 cases, ductal carcinoma in the lower bile duct in 4 cases, (2 cases), cystadenoma (3 cases), chronic pancreatitis (1 case), intrahepatic cholangiocarcinoma (1 case), cystic duct infiltration duodenum (1 case) patient. The average age of the patients was 65 years old (42-80 years). The average operation time was 386min (260-510min), mean intraoperative blood loss was 340ml (30-1600ml), average postoperative hospital stay was 14 days (10-21 days) Postoperative mortality was 0. [Conclusion] The four-hole laparoscopic pancreatoduodenectomy with anti-“V” route is safe and effective, which is suitable for some specific cases in clinical practice. For patients with local malignant lesions, regardless of pathology, this method are applicable. Preliminary clinical experience shows that anti- “V ” path laparoscopic pancreatoduodenectomy has good application prospects, and even applicable to liver resection combined with pancreatoduodenectomy.