腹腔镜胰十二指肠切除术治疗胰头癌57例疗效

摘要

Objective To study the feasibility of laparoscopic pancreaticoduodenectomy ( LPD) in the treatment of pancreatic head cancer, and to analyze the short-term postoperative outcomes. Methods The clinical data of 57 patients with pancreatic head cancer who underwent laparoscopic pancreaticoduode-nectomy from April 2015 to November 2017 in the Second Hospital of Hebei Medical University were retro-spectively analyzed. Results Of the 57 patients, conversion to open surgery was required in 2 patients, and major venous resection and reconstruction were performed in 9 patients, including 8 end-to-end anastomosis, and 1 synthetic graft interposition. Total pancreatectomy was carried out in 4 patients. For the remaining 53 patients, pancreaticojejunal mucosal anastomoses were carried out in 50 patients, and sleeve pancreaticojeju-nostomy in 3 patients. The mean operative time and operative blood loss were 497 (240～720) min and 435 (50～3 000 ) ml, respectively. The mean postoperative hospital stay was 17. 7 ( 6. 0 ～59. 0 ) days. Postoperative complications were detected in 26. 3% (15/57) of patients, which included delayed gastric emptying (DGE) in 4 patients, Grade B pancreatic fistula (PF) in 4 patients, biliary fistula ( BF) in 2 patients, postpancreatectomy hemorrhage ( PPH) in 2 patients, intraabdominal infection in 1 patient and pulmonary infection in 2 patients. All the patients with DGE recovered with conservative treatment and they were discharged home. Reoperation was only required in the two patients with PPH. One patient died after the operation. The postoperative pathological results revealed pancreatic duct adenocarcinoma in 53 patients, adenosscale carcinoma in 1 patient and neuroendocrine carcinoma in 3 patients. The maximum and minimum tumor sizes were 7. 0 cm×5. 0 cm×3. 5 cm and 2. 5 cm×1. 5 ×1. 0 cm, respectively. The mean lymph nodes harvest and positive lymph node retrieval were 14(1～60) and 0. 7(0～3), respectively. Negative resection margins were obtained in 84. 2% (48/57) of patients. This study was censored on December 31, 2017. The follow-up for these patients ranged between 1 to 32 months. Mortality occurred in 21 patients, including 1 patient with a ruptured aneurysm 2 months after operation, 2 patients with GI bleeding 2 and 9 months respectively after operation, 1 patient with severe pulmonary infection and 17 patients with cancer recurrence with survival varying from 2 to 21 months. 35 patients were still alive. Conclusion Laparoscopic pancreaticoduodenectomy is a safe and feasible procedure for pancreatic head cancer.%目的 探讨腹腔镜胰十二指肠切除术( LPD)治疗胰头癌的可行性以及近期疗效.方法 回顾性分析2015年4月至2017年11月河北医科大学第二医院肝胆外科同一团队开展的57例胰头癌患者行LPD的临床资料.结果 57例患者中,2例中转开腹手术.其中联合血管切除重建9例,重建方式包括门静脉端端吻合8例,门静脉人工血管置换1例,全胰切除4例.胰肠吻合采用胰管空肠黏膜吻合50例,套入式胰肠吻合3例.患者平均手术时间497 (240～720)min,术中出血量435(50～3 000)ml,术后住院时间17. 7(6. 0 ～59. 0)d. 53 例胰肠吻合患者术后发生B级胰瘘4 例(7. 5% ),无C级胰瘘;胆瘘2例(3. 8% ).患者术后并发症发生率为26. 3% (15/57),经治疗后均症状好转顺利出院.患者术后因出血再次手术2 例(3. 5% ).腹部感染1 例(1. 8% ),肺部感染2 例(3. 5% ).围手术期死亡1 例(1. 8% ).术后病理学检查结果:胰腺导管腺癌53 例,胰腺腺鳞癌1例,神经内分泌癌3例.本组患者肿瘤最小为2. 5 cm×1. 5 cm×1. 0 cm,最大为7. 0 cm×5. 0 cm× 3. 5 cm,平均淋巴结获取率为14 (1 ～60)个,平均阳性淋巴结数目0. 7 (0 ～3)个. 57 例中48 例(84. 2% )达到R0切除.截至2017年12月31日,对患者随访1～32个月,结果显示21例死亡,其中1例因术后2月动脉瘤破裂腹腔出血死亡,2例分别因术后2、9个月突发消化道出血死亡,1例因术后9个月突发高热、肺部感染死亡,另17 例因为肿瘤复发死亡.死亡患者术后生存期2 ～21 个月.其余35例患者仍在随访中.结论 在较大的胰腺外科中心,应用LPD治疗胰腺癌安全可行.