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目的介绍我中心在胰头恶性肿瘤侵犯周围血管以及肿块型胰腺炎合并致密炎症粘连等困难情况下所采用的个体化腹腔镜胰十二指肠切除术。方法回顾性分析我院近年来开展的困难情况下的腹腔镜胰十二指肠切除术的2例病例资料，包括手术策略、手术时间、术中出血情况、术后住院时间、治疗方案及预后情况。结果患者1，65岁男性患者，术前诊断为胰腺钩突占位伴肠系膜上静脉侵犯、梗阻性黄疸。术中行肠系膜上动脉优先入路的联合肠系膜上静脉切除重建的腹腔镜胰十二指肠切除术（操作见视频1），手术时间340 min，出血200 mL，术中未输血。患者术后康复顺利，术后住院9 d。术后病理学诊断：胰腺中-低分化导管腺癌。患者行GS（吉西他滨+替吉奥）方案化疗6个周期，术后1年随访患者情况良好，无复发转移情况。患者2，47岁中年男性，因反复腹痛入院，术前诊断胰头占位伴梗阻性黄疸，既往接受过开腹Roux-en-Y胆肠吻合术、小肠切除、肠肠吻合术。术中采用超声刀、电钩、剪刀等多种方式处理患者腹腔不同部位粘连，调整传统模块化手术流程行腹腔镜胰十二指肠切除术，改用Easy-first原则行手术切除（操作见视频2）。术中采取双主刀模式处理例如出血等突发情况。手术时间400 min，出血500 mL，术中未输血。患者术后康复顺利，术后住院11 d。术后病理学诊断为胰头部慢性炎症肿块，最大径6 cm，未见明显癌变。术后20个月随访患者情况良好，未再发急性胰腺炎。结论在有经验的胰腺微创中心，通过不同的手术方式、采取个体化的手术策略，当肿瘤侵犯周围血管以及肿块型胰腺炎合并致密炎症粘连等情况腹腔镜胰十二指肠切除术是安全可行的。“,”ObjectiveTo explore the individualized surgical strategies and surgical methods which can greatly improve the efficacy and safety of laparoscopic pancreaticoduodenectomy in difficult and complicated situations, such as pancreatic head malignant tumors invade the major vascular and chronic pancreatitis with severe abdominal adhesions.MethodsCase 1: A 65-year-old man with jaundice was diagnosed preoperatively with a pancreatic acinus process with superior mesenteric vein (SMV) invasion. In order to ensure R0 resection, the patient underwent laparoscopic pancreaticoduodenectomy combined with SMV resection and reconstruction, taking the way of the superior mesenteric artery (SMA)-first approach. The length of SMV removed was 2 cm (see the Video 1 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760501). The portal vein (PV)-SMV occlusion time was 26 min, the reconstruction time was 17 min. The duration of the surgery was 340 min, with 200 mL of blood loss and no transfusion. Case 2: A 47-year-old man with abdominal pain was admitted with preoperative diagnosis of pancreatic head mass with obstructive jaundice. His past medical history included small bowel resection and bowel anastomosis for abdominal trauma, open Roux-en-Y choledochojejunostomy for acute pancreatitis and obstructive jaundice. In the operation, we used ultracision harmonic scalpel, hook electrode, laparoscopic scissors, and other means to separate the adhesion of different parts of the abdominal, adjusted traditional modular surgical procedure for laparoscopic pancreaticoduodenectomy with Easy First strategy to perform surgical resection (see the Video 2 in Supplemental Contents, http://ykxb.scu.edu.cn/article/doi/10.12182/20200760501). Emergencies such as mass bleeding, used Two Chief Surgeons Model to control bleeding and suture the bleeding site. The duration of the surgery was 400 min, with 500 mL of blood loss and no transfusion.ResultsCase 1: The patient’s postoperative course was uneventful, with a hospital stay of 9 d. Histology confirmed the diagnosis of a 3.6 cm×2.4 cm×1.8 cm pancreatic ductal adenocarcinoma tumor (R0 and lymph nodes 1/26, AJCC 8th T2N1M0, stage ⅡA). The removed SMV layer was invased and the cut edges were negative. The patient underwent 6 cycles of GS (gemcitabine+tegio) chemotherapy. The patient was asymptomatic 1 year later, with no tumor recurrence and no pancreatic insufficiency. Case 2: The patient’s postoperative course was uneventful, with a hospital stay of 11 d. Histology confirmed the diagnosis of a 6 cm pancreatic inflammatory mass. The patient was asymptomatic 20 months later, with no recurrence of acute pancreatitis again. ConclusionWith different surgical methods and individualized surgical strategies, laparoscopic pancreaticoduodenectomy in difficult and complicated situations is safe and feasible in the experienced pancreas minimally invasive center.