Edwin B, Mala T, Mathisen Ø, Gladhaug I, Buanes T, Lunde O C, Søreide O, Bergan A, Fosse E
Interventional Center and Surgical Department, Rikshospitalet, Oslo, Norway.
Surg Endosc. 2004 Mar;18(3):407-11. doi: 10.1007/s00464-003-9007-y. Epub 2004 Feb 2.
Laparoscopic resection is not an established treatment for tumors of the pancreas. We report our preliminary experience with this innovative approach to pancreatic disease.
Thirty two patients with pancreatic disease were included in the study on an intention-to-treat basis. The preoperative indications for surgery were as follows: neuroendocrine tumors ( n=13), unspecified tumors ( n=11), cysts ( n=2), idiopathic thrombocytopenic purpura with ectopic spleen ( n=2), annular pancreas ( n=1), trauma ( n=1), aneurysm of the splenic artery ( n=1), and adenocarcinoma ( n=1).
Enucleations ( n=7) and distal pancreatectomy with ( n=12) and without splenectomy ( n=5) were performed. Three patients underwent laparoscopic exploration only. Four procedures (13%) were converted to an open technique. One resection was converted to a hand-assisted procedure. The mortality rate for patients undergoing laparoscopic resection was 8.3% (two of 24). Complications occurred after resection in nine of 24 procedures (38%). The median hospital stay was 5.5 days (range, 2-22). Postoperatively, opioid medication was given for a median of 2 days (range, 0-13).
Resection of the pancreas can be performed safely via the laparoscopic approach with all the potential benefits to the patients of minimally invasive surgery.
腹腔镜切除术并非治疗胰腺肿瘤的既定疗法。我们报告了我们采用这种创新方法治疗胰腺疾病的初步经验。
32例胰腺疾病患者纳入意向性治疗研究。手术的术前指征如下：神经内分泌肿瘤（n = 13）、未明确的肿瘤（n = 11）、囊肿（n = 2）、伴有异位脾的特发性血小板减少性紫癜（n = 2）、环状胰腺（n = 1）、创伤（n = 1）、脾动脉动脉瘤（n = 1）和腺癌（n = 1）。
实施了摘除术（n = 7）、有脾切除术（n = 12）和无脾切除术（n = 5）的远端胰腺切除术。3例患者仅接受了腹腔镜探查。4例手术（13%）转为开放手术。1例切除术转为手辅助手术。接受腹腔镜切除术患者的死亡率为8.3%（24例中的2例）。24例手术中有9例（38%）在切除术后出现并发症。中位住院时间为5.5天（范围2 - 22天）。术后，阿片类药物的使用时间中位数为2天（范围0 - 13天）。
胰腺切除术可通过腹腔镜方法安全实施，具有微创手术给患者带来的所有潜在益处。
