Liao Chien-Hung, Wu Yu-Tung, Liu Yu-Yin, Wang Shang-Yu, Kang Shih-Ching, Yeh Chun-Nan, Yeh Ta-Sen
Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
World J Surg. 2016 May;40(5):1218-25. doi: 10.1007/s00268-016-3433-1.
Minimally invasive pancreaticoduodenectomy (MIPD), which includes laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is a complex procedure that needs to be performed by experienced surgeons. However, the safety and oncologic performance have not yet been conclusively determined.
A systematic literature search was performed using the Embase, Medline, and PubMed databases to identify all studies published up to March 2015. Articles written in English containing the keywords: "pancreaticoduodenectomy" or "Whipple operation" combined with "laparoscopy," "laparoscopic," "robotic," "da vinci," or "minimally invasive surgery" were selected. Furthermore, to increase the power of evidence, articles describing more than ten MIPDs were selected for this review.
Twenty-six articles matched the review criteria. A total of 780 LPDs and 248 RPDs were included in the current review. The overall conversion rate to open surgery was 9.1 %. The weighted average operative time was 422.6 min, and the weighted average blood loss was 321.1 mL. The weighted average number of harvested lymph nodes was 17.1, and the rate of microscopically positive tumor margins was 8.4 %. The cumulative morbidity was 35.9 %, and a pancreatic fistula was reported in 17.0 % of cases. The average length of hospital stay was 12.4 days, and the mortality rate was 2.2 %.
In conclusion, after reviewing one-thousand cases in the current literature, we conclude that MIPD offers a good perioperative, postoperative, and oncologic outcome. MIPD is feasible and safe in well-selected patients.
微创胰十二指肠切除术（MIPD），包括腹腔镜胰十二指肠切除术（LPD）和机器人胰十二指肠切除术（RPD），是一项复杂的手术，需要由经验丰富的外科医生进行。然而，其安全性和肿瘤学疗效尚未得到最终确定。
使用Embase、Medline和PubMed数据库进行系统的文献检索，以识别截至2015年3月发表的所有研究。选择用英文撰写的包含关键词：“胰十二指肠切除术”或“惠普尔手术”并与“腹腔镜检查”、“腹腔镜的”、“机器人的”、“达芬奇”或“微创手术”相结合的文章。此外，为了增强证据的说服力，本综述选择了描述超过十例MIPD的文章。
26篇文章符合综述标准。本综述共纳入780例LPD和248例RPD。转为开放手术的总体转化率为9.1%。加权平均手术时间为422.6分钟，加权平均失血量为321.1毫升。加权平均清扫淋巴结数为17.1个，镜下切缘阳性率为8.4%。累积发病率为35.9%，17.0%的病例报告有胰瘘。平均住院时间为12.4天，死亡率为2.2%。
总之，在回顾了当前文献中的一千例病例后，我们得出结论，MIPD具有良好的围手术期、术后和肿瘤学结局。MIPD在精心挑选的患者中是可行且安全的。
