Parekh Dilip
Department of Surgery, University of Southern California, Los Angeles, CA, USA.
Arch Surg. 2006 Sep;141(9):895-902; discussion 902-3. doi: 10.1001/archsurg.141.9.895.
Open surgery for pancreatic debridement is often associated with major morbidity such as wound complications, fascial dehiscence, and intestinal fistulae. Hand-assisted laparoscopic surgery (HALS) is useful for complex abdominal procedures since the benefits of traditional laparoscopic surgery are retained. Published experience with HALS for pancreatic debridement is limited to anecdotal case reports.
University-affiliated private and public hospitals.
Twenty-three patients with necrotizing pancreatitis were evaluated and 19 patients underwent pancreatic debridement from 2001 to 2006. A GelPort (Applied Medical, Rancho Santa Margarita, Calif) was used to provide laparoscopic hand access. In the majority of the patients, an infracolic approach was used to access the pancreatic necrosis.
Nineteen patients underwent laparoscopic evacuation of pancreatic necrosis, and in 18 patients, the procedure was completed. The mean age was 54 years; the mean +/- SEM body mass index, calculated as weight in kilograms divided by height in meters squared, was 32.0 +/- 2.6; the mean American Society of Anesthesiologists score was 3.4; and 7 of 19 patients had past history organ failure. The mean +/- SEM operating time was 153 +/- 10 minutes and mean +/- SEM blood loss was 352.6 +/- 103 mL. Four patients required reoperations, 2 using HALS and 2 open. There were no postoperative complications related to the HAL procedure itself, such as major wound infections, intestinal fistulae, or postoperative hemorrhage. Postoperative computed tomographic scans confirmed adequacy of debridement. The mean +/- SEM length of hospital stay after surgery was 16.3 +/- 3.8 days.
This is the largest reported study of laparoscopic debridement for pancreatic necrosis. The procedure is feasible and associated with a low morbidity and mortality. Pancreatic debridement with HALS may provide a new option for the surgical treatment of selected patients with severe necrotizing pancreatitis.
胰腺清创的开放手术常伴有严重并发症，如伤口并发症、筋膜裂开和肠瘘。手辅助腹腔镜手术（HALS）对复杂腹部手术有用，因为保留了传统腹腔镜手术的优点。已发表的关于HALS用于胰腺清创的经验仅限于个案报道。
大学附属的私立和公立医院。
对23例坏死性胰腺炎患者进行了评估，2001年至2006年期间19例患者接受了胰腺清创。使用GelPort（应用医疗公司，加利福尼亚州兰乔圣玛格丽塔）提供腹腔镜手辅助通道。大多数患者采用结肠下途径进入胰腺坏死部位。
19例患者接受了腹腔镜下胰腺坏死组织清除术，18例患者完成了手术。平均年龄为54岁；平均±标准误体重指数（按千克体重除以身高米的平方计算）为32.0±2.6；平均美国麻醉医师协会评分为3.4；19例患者中有7例有既往器官衰竭史。平均±标准误手术时间为153±10分钟，平均±标准误失血量为352.6±103毫升。4例患者需要再次手术，2例采用HALS，2例采用开放手术。没有与HALS手术本身相关的术后并发症，如严重伤口感染、肠瘘或术后出血。术后计算机断层扫描证实清创充分。术后平均±标准误住院时间为16.3±3.8天。
这是报道的关于腹腔镜下胰腺坏死清创术的最大规模研究。该手术可行，发病率和死亡率低。HALS胰腺清创术可能为部分严重坏死性胰腺炎患者的手术治疗提供新选择。
