Park A, Schwartz R, Tandan V, Anvari M
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0298, USA.
Am J Surg. 1999 Feb;177(2):158-63. doi: 10.1016/s0002-9610(98)00325-0.
Potential applications for laparoscopic surgery in pancreatic disease include (1) staging of pancreatic malignancies; (2) palliation of pancreatic malignancies; (3) pancreatic resections for benign and malignant disease; and (4) pancreatic drainage procedures.
A review of the literature is presented. In addition, original data on a series of 5 laparoscopic pancreatic distal resections and 10 laparoscopic cystogastrostomies are presented.
Laparoscopy may have a role in the staging of patients with pancreatic malignancies; however, with high-quality preoperative imaging, the percentage of patients who will benefit from laparoscopy may be as low as 5%. For palliation, both cholecystoenterostomy and choledochoenterostomy can be performed laparoscopically. The former is technically straightforward but has a higher failure rate; the latter is technically difficult and currently not suitable for widespread adoption. Laparoscopic gastroenterostomy is a straightforward means of palliating gastrointestinal obstruction. Patients appear to benefit from laparoscopic distal pancreatic resection but not from laparoscopic pancreaticoduodenectomy. Patients appear to benefit from laparoscopic pseudocyst decompression.
腹腔镜手术在胰腺疾病中的潜在应用包括：（1）胰腺恶性肿瘤的分期；（2）胰腺恶性肿瘤的姑息治疗；（3）良性和恶性疾病的胰腺切除术；（4）胰腺引流手术。
本文对相关文献进行了综述。此外，还展示了一系列5例腹腔镜胰腺远端切除术和10例腹腔镜囊肿胃吻合术的原始数据。
腹腔镜检查在胰腺恶性肿瘤患者的分期中可能有一定作用；然而，有高质量的术前影像学检查时，能从腹腔镜检查中获益的患者比例可能低至5%。对于姑息治疗，胆囊肠吻合术和胆总管空肠吻合术均可通过腹腔镜进行。前者技术操作简单，但失败率较高；后者技术难度大，目前不适合广泛应用。腹腔镜胃肠吻合术是缓解胃肠道梗阻的一种直接方法。患者似乎能从腹腔镜胰腺远端切除术中获益，但不能从腹腔镜胰十二指肠切除术中获益。患者似乎能从腹腔镜假性囊肿减压术中获益。
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