Kendrick Michael L, Cusati Daniel
Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Arch Surg. 2010 Jan;145(1):19-23. doi: 10.1001/archsurg.2009.243.
Total laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach.
Single-institutional retrospective review.
Tertiary referral center.
All consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from July 2007 through July 2009 at a single center (n = 62).
Blood loss, operative time, postoperative morbidity, length of hospital stay, and 30-day or in-hospital mortality.
Of 65 patients undergoing laparoscopic resection, 62 patients with a mean age of 66 years (SD, 12 years) underwent total laparoscopic pancreaticoduodenectomy. The pancreaticojejunostomy consisted of a duct-to-mucosa anastomosis with interrupted suture. Median operative time was 368 minutes (range, 258-608 minutes) and median blood loss was 240 mL (range, 30-1200 mL). Diagnosis was pancreatic adenocarcinoma (n = 31), intraductal papillary mucinous neoplasm (n = 12), periampullary adenocarcinoma (n = 8), neuroendocrine tumor (n = 4), chronic pancreatitis (n = 3), cholangiocarcinoma (n = 1), metastatic renal cell carcinoma (n = 1), cystadenoma (n = 1), and duodenal adenoma (n = 1). Median tumor size was 3 cm (range, 0.9-10.0 cm) and the median number of lymph nodes harvested was 15 (range, 6-31). Perioperative morbidity occurred in 26 patients and included pancreatic fistula (n = 11), delayed gastric emptying (n = 9), bleeding (n = 5), and deep vein thrombosis (n = 2). There was 1 postoperative mortality. Median length of hospital stay was 7 days (range, 4-69 days).
Laparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.
全腹腔镜胰十二指肠切除术是一种安全有效的治疗方法。
单机构回顾性研究。
三级转诊中心。
2007年7月至2009年7月在单一中心接受全腹腔镜胰十二指肠切除术的所有连续患者（n = 62）。
失血量、手术时间、术后发病率、住院时间以及30天或住院死亡率。
在65例行腹腔镜切除术的患者中，62例平均年龄66岁（标准差12岁）的患者接受了全腹腔镜胰十二指肠切除术。胰肠吻合采用导管对黏膜间断缝合。中位手术时间为368分钟（范围258 - 608分钟），中位失血量为240毫升（范围30 - 1200毫升）。诊断为胰腺腺癌（n = 31）、导管内乳头状黏液性肿瘤（n = 12）、壶腹周围腺癌（n = 8）、神经内分泌肿瘤（n = 4）、慢性胰腺炎（n = 3）、胆管癌（n = 1）、转移性肾细胞癌（n = 1）、囊腺瘤（n = 1）和十二指肠腺瘤（n = 1）。中位肿瘤大小为3厘米（范围0.9 - 10.0厘米），中位清扫淋巴结数为15个（范围6 - 31个）。26例患者发生围手术期并发症，包括胰瘘（n = 11）、胃排空延迟（n = 9）、出血（n = 5）和深静脉血栓形成（n = 2）。有1例术后死亡。中位住院时间为7天（范围4 - 69天）。
腹腔镜胰十二指肠切除术可行、安全且有效。其结果似乎与开放手术相当；然而，仍需要对照试验。尽管本系列代表了学习曲线内的经验，但腹腔镜胰十二指肠切除术有望提供在其他手术中所见的微创方法的优势。
