Nakamura Yoshiharu, Matsumoto Satoshi, Yoshioka Masato, Shimizu Tetsuya, Yamahatsu Kazuya, Uchida Eiji
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2012;79(3):218-22. doi: 10.1272/jnms.79.218.
Like other forms of laparoscopic surgery, laparoscopic pancreaticoduodenectomy (Lap-PD) is a minimally invasive procedure that can greatly reduce bleeding during surgery. We performed Lap-PD for a case of intraductal papillary mucinous neoplasm. To remove the resected tissue from the body, we made a small incision directly above the line of transection of the distal pancreas (the cut stump). This procedure requires complex reconstructive procedures, which we performed through the same small incision. All reconstructive procedures, except for hepaticojejunostomy, were performed under direct visualization; hepaticojejunostomy was performed laparoscopically. The reconstructive surgery was effective and was as safe as open abdominal surgery. We also discuss the value of using an endoscopic linear stapler for Lap-PD pancreatic transection, to reduce extravasation of pancreatic fluid into the abdominal cavity during the resection of tumors involving the pancreatic ducts, such as intraductal papillary mucinous neoplasm.
与其他形式的腹腔镜手术一样，腹腔镜胰十二指肠切除术（Lap-PD）是一种微创手术，可大大减少手术期间的出血。我们对一例导管内乳头状黏液性肿瘤患者进行了Lap-PD手术。为了将切除的组织从体内取出，我们在胰腺远端横断线（切断残端）正上方做了一个小切口。该手术需要复杂的重建手术，我们通过同一个小切口进行了这些操作。除肝空肠吻合术外，所有重建手术均在直视下进行；肝空肠吻合术通过腹腔镜进行。重建手术效果良好，且与开腹手术一样安全。我们还讨论了在Lap-PD胰腺横断术中使用内镜直线切割吻合器的价值，以减少在切除涉及胰管的肿瘤（如导管内乳头状黏液性肿瘤）时胰液渗入腹腔的情况。
