Pugliese Raffaele, Scandroglio Ildo, Sansonna Fabio, Maggioni Dario, Costanzi Andrea, Citterio Davide, Ferrari Giovanni Carlo, Di Lernia Stefano, Magistro Carmelo
Department of Surgery, Niguarda Hospital, Milan, Italy.
Surg Laparosc Endosc Percutan Tech. 2008 Feb;18(1):13-8. doi: 10.1097/SLE.0b013e3181581609.
The role of laparoscopic techniques in pancreatic surgery is still controversial especially regarding to exocrine malignancies. Operative time, conversion rate, adequacy of dissection, and morbidity do represent factors of major concern. Whereas laparoscopic resection of left sided pancreatic lesions requires no anastomosis and therefore has gained worldwide acceptance over the last years, excision of cephalic lesions by mimimal access has little place in surgeons' practice because of its technical complexity and duration of surgery. This study was designed to assess the feasibility and results of laparoscopic pancreaticoduodenectomy for neoplasms of the pancreatic head, analyzing steps of learning curve, conversion rate, and short-term outcomes. From August 2002 to December 2006, 19 patients affected by pancreatic neoplasm of the head were approached by minimally invasive technique. A video-assisted procedure with pancreaticoduodenal resection and anastomoses fashioned through a midline minilaparotomy of 7 cm was achieved in 7 patients. Conversion to laparotomy was required in 6 patients, in 3 for bleeding and in 3 for difficulties in dissection. Cephalic pancreatoduodenectomy was achieved by thorough intracorporeal technique in 6 patients. Mortality was nil. Oncologic principles with adequate lymphadenectomy and resection margins were respected and short-term outcomes and mean survival were quite acceptable and equal to those of conventional surgery.
腹腔镜技术在胰腺手术中的作用仍存在争议，尤其是在外分泌恶性肿瘤方面。手术时间、中转率、解剖的充分性和发病率确实是主要关注的因素。虽然腹腔镜切除左侧胰腺病变无需吻合，因此在过去几年中已获得全球认可，但由于技术复杂性和手术时间，通过微创切除胰头病变在外科医生的实践中应用较少。本研究旨在评估腹腔镜胰十二指肠切除术治疗胰头肿瘤的可行性和结果，分析学习曲线步骤、中转率和短期结果。2002年8月至2006年12月，采用微创技术对19例胰头肿瘤患者进行了治疗。7例患者通过视频辅助手术完成了胰十二指肠切除并通过7cm的中线小切口进行吻合。6例患者需要中转开腹，3例因出血，3例因解剖困难。6例患者通过完全腹腔镜技术完成了胰头十二指肠切除术。无死亡病例。遵循了充分淋巴结清扫和切缘的肿瘤学原则，短期结果和平均生存期相当可观，与传统手术相当。
