Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Surg Endosc. 2013 Jan;27(1):95-103. doi: 10.1007/s00464-012-2427-9. Epub 2012 Jun 30.
Few reports describe the use of laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) in centers with experience using this technique. In addition, the clinical outcomes of this procedure remain undetermined.
In the current study, 100 patients with benign or malignant lesions in the pancreatic head underwent LPPPD between May 2007 and December 2011. The overall clinical outcomes and changes in these outcomes during the surgeon learning period were analyzed to assess the feasibility and safety of this procedure.
Pathologic examination of the pancreas confirmed intraductal papillary mucinous neoplasms in 37 patients, solid pseudopapillary tumors in 17 patients, neuroendocrine tumors in 15 patients, serous cystic neoplasms in seven patients, pancreatic ductal adenocarcinomas in seven patients, ampulla of Vater tumors and duodenal gastrointestinal stromal tumors in five patients, and other disease in seven patients. The median operative time was 7.9 h, which decreased with accumulating experience of the surgeon using this procedure, from 9.8 h for the first 33 cases to 6.6 h for the last 34 cases. Complications developed in 25% of the patients, including six cases (6%) with significant pancreatic fistula [International Study Group on Pancreatic Fistula (ISGPF) grade B]. The complication rate decreased from 33.3% for the first 33 cases to 17.6% for the last 34 cases. The mean hospital stay was 14 days, which also decreased from 20.4 days for the first 33 cases to 11.5 days for the last 34 cases. For the 12 patients in the study cohort with invasive malignant disease, the median tumor size was 2.8 cm, and the median number of lymph nodes harvested was 13. All the patients had margin-negative R0 resections.
The LPPPD procedure is technically safe and feasible, with an acceptable rate of morbidity and other clinical outcomes for benign and malignant diseases. Clinical outcomes can be improved once a learning curve has been overcome.
很少有报道描述在具有使用该技术经验的中心使用腹腔镜保留幽门胰十二指肠切除术（LPPPD）的情况。此外，该手术的临床效果仍不确定。
本研究回顾性分析 2007 年 5 月至 2011 年 12 月期间 100 例行 LPPPD 的胰头部良性或恶性病变患者的临床资料。分析整体临床效果和术者学习期间的效果变化，以评估该手术的可行性和安全性。
病理检查证实胰腺内导管乳头状黏液性肿瘤 37 例，实性假乳头状瘤 17 例，神经内分泌肿瘤 15 例，浆液性囊腺瘤 7 例，胰腺导管腺癌 7 例，壶腹周围癌和十二指肠胃肠道间质瘤 5 例，其他疾病 7 例。中位手术时间为 7.9 h，随着术者使用该技术经验的积累而逐渐减少，从第 1 至 33 例的 9.8 h 减少至最后 34 例的 6.6 h。25%的患者发生并发症，其中 6 例（6%）为严重胰瘘[国际胰腺瘘研究组（ISGPF）分级 B]。并发症发生率从第 1 至 33 例的 33.3%降至最后 34 例的 17.6%。中位住院时间为 14 天，从第 1 至 33 例的 20.4 天减少至最后 34 例的 11.5 天。研究队列中 12 例侵袭性恶性疾病患者的肿瘤中位大小为 2.8 cm，中位淋巴结清扫数目为 13 枚。所有患者均行阴性切缘的 R0 切除。
LPPPD 手术技术安全可行，用于治疗良性和恶性疾病的并发症发生率和其他临床效果可接受。一旦克服学习曲线，临床效果可以得到改善。
