Gagner Michel, Palermo Mariano
Department of Surgery, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA.
J Hepatobiliary Pancreat Surg. 2009;16(6):726-30. doi: 10.1007/s00534-009-0142-2. Epub 2009 Jul 28.
Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use. In the past, minimally invasive techniques were only used for diagnostic laparoscopy, staging of pancreatic cancer, and palliative procedures for unresectable pancreatic cancer. With new advances in technology and instrumentation, some sophisticated procedures are currently available, such as the Whipple procedure, one of the most sophisticated applications of minimally invasive surgery.
A review of the literature shows that 146 laparoscopic Whipple procedures have been published worldwide since 1994. The authors analyzed blood loss, mean operating time, hospital stay, conversion rate, mean age, mortality rate, lymph nodes in the pathologic findings, follow up, and complications.
Mean age was 59.1 years; mean operating time was 439 min. The average blood loss for the reviewed literature was 143 mL; median hospital stay was 18 days; conversion rate was 46%; number of lymph nodes in the pathologic findings was 19; and mortalities related to the procedure was low, 2 patients (1.3%) and the complication rate was 16% (23/46 patients). Complications included 2 hemorrhages, 4 bowel obstructions, 1 stress ulcer, 1 delay of gastric emptying, 4 pneumonias, and 11 leaks.
This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.
腹腔镜胰腺手术是目前腹腔镜手术中最先进的应用之一。过去，微创技术仅用于诊断性腹腔镜检查、胰腺癌分期以及不可切除胰腺癌的姑息性手术。随着技术和器械的新进展，目前已有一些复杂的手术可供选择，例如惠普尔手术，这是微创手术最复杂的应用之一。
文献回顾显示，自1994年以来，全球已发表了146例腹腔镜惠普尔手术。作者分析了失血量、平均手术时间、住院时间、中转率、平均年龄、死亡率、病理检查中的淋巴结情况、随访及并发症。
平均年龄为59.1岁；平均手术时间为439分钟。所回顾文献的平均失血量为143毫升；中位住院时间为18天；中转率为46%；病理检查中的淋巴结数量为19个；与手术相关的死亡率较低，为2例患者（1.3%），并发症发生率为16%（23/46例患者）。并发症包括2例出血、4例肠梗阻、1例应激性溃疡、1例胃排空延迟、4例肺炎和11例渗漏。
本综述表明，腹腔镜惠普尔手术不仅可行，而且安全，死亡率低，并发症发生率可接受。
