Takaori Kyoichi, Tanigawa Nobuhiko
Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
Surg Today. 2007;37(7):535-45. doi: 10.1007/s00595-007-3472-1. Epub 2007 Jun 26.
Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreatic surgeries. Laparoscopic pancreatic resections have been performed in patients with a variety of diseases including chronic pancreatitis, pancreatic trauma, congenital hyperinsulinism, and neoplasms of the pancreas; e.g., insulinoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, etc. Laparoscopic pancreatic resections with an en bloc lymph node dissection have also been performed for invasive carcinomas. The long-term results after laparoscopic resections for invasive pancreatic cancer, however, are still not well defined. Laparoscopic distal pancreatectomies with or without spleen preservation may benefit patients with reduced postoperative pain, shorter hospital stay, a quicker recovery to normal activity, and better cosmetic appearances based on retrospective analyses of collective series and case reports. Prospective randomized controlled trials are needed to validate these benefits. In contrast, laparoscopic proximal pancreatectomies with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving pancreatic head resection are technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences by highly skilled endoscopic surgeons. To justify the performance of laparoscopic proximal pancreatectomies, it is mandatory to demonstrate the potential clinical benefits and safety of these complicated procedures.
自20世纪90年代初以来,腹腔镜技术已应用于越来越多的胰腺手术。腹腔镜胰腺切除术已在患有多种疾病的患者中进行,包括慢性胰腺炎、胰腺创伤、先天性高胰岛素血症和胰腺肿瘤,例如胰岛素瘤、黏液性囊性肿瘤、导管内乳头状黏液性肿瘤等。对于浸润性癌,也已进行了腹腔镜胰腺切除术并整块清扫淋巴结。然而,腹腔镜切除浸润性胰腺癌后的长期结果仍不明确。根据对系列病例和病例报告的回顾性分析,保留或不保留脾脏的腹腔镜远端胰腺切除术可能使患者术后疼痛减轻、住院时间缩短、更快恢复正常活动且美容效果更好。需要进行前瞻性随机对照试验来证实这些益处。相比之下,保留或不保留十二指肠的腹腔镜近端胰腺切除术仍存在争议。虽然腹腔镜胰十二指肠切除术和腹腔镜保留十二指肠的胰头切除术在技术上是可行的,但近端胰腺切除术后的腹腔镜重建目前尚未普遍可行,仅限于高技能内镜外科医生的个人经验。为了证明腹腔镜近端胰腺切除术的合理性,必须证明这些复杂手术的潜在临床益处和安全性。