Moscow Clinical Scientific Centre, Moscow, Russia; Moscow State University of Medicine and Dentistry, Moscow, Russia.
Moscow Clinical Scientific Centre, Moscow, Russia; Moscow State University of Medicine and Dentistry, Moscow, Russia.
Pancreatology. 2017 Nov-Dec;17(6):936-942. doi: 10.1016/j.pan.2017.08.007. Epub 2017 Aug 19.
Laparoscopic pancreatoduodenectomy (LPD) remains one of the most challenging minimal invasive operations today.
Between January 2007 and December 2016, 197 patients were scheduled for LPD but 162 patients (from January 2007 to July 2016) were analysed in this cohort series.
Total LPD concerned for 162 patients (five patients did not undergo PD and 12 underwent conversion): standard LPD in 104 patients (66%), and laparoscopic pylorus-preserving PD in 41 patients (26%). Median operative time was 415 (240-765) min. Median blood loss was 200 (50-2100) ml. Twelve patients required blood transfusion. Clinically relevant pancreatic fistula (ISGPF grades B and C) occurred in 21 (13%) patients: 16 (10.0%) grade B, and 5 (3%) grade C. Grades B and C delayed gastric emptying occurred in five patients each. Grades B and C post-pancreatectomy bleeding occurred in 9 (5.7%) and 3 (1.9%) patients, respectively. LPD was performed for 18 (11.4%) benign and 139 (88.5%) malignant lesions. Superior mesenteric and/or portal vein involvement required major venous resection in eight patients. The 90-day mortality 5.0%. The median overall survival for pancreatic ductal adenocarcinoma was 22.5 months.
Morbidity and mortality for LPD are comparable to open procedures rates in the literature. Laparoscopic major venous resection is feasible and safe.
腹腔镜胰十二指肠切除术（LPD）仍然是当今最具挑战性的微创手术之一。
2007 年 1 月至 2016 年 12 月，197 例患者拟行 LPD，但本队列研究仅分析了其中 162 例患者（2007 年 1 月至 2016 年 7 月）。
162 例患者行 LPD（5 例患者未行 PD，12 例患者中转开腹）：标准 LPD 104 例（66%），腹腔镜保留幽门胰十二指肠切除术 41 例（26%）。中位手术时间为 415（240-765）min。中位出血量为 200（50-2100）ml，12 例患者需要输血。13%（21 例）患者发生临床相关胰瘘（ISGPF 分级 B 和 C）：16 例（10.0%）为 B 级，5 例（3%）为 C 级。B 级和 C 级延迟胃排空分别发生在 5 例患者中。B 级和 C 级胰周出血分别发生在 9 例（5.7%）和 3 例（1.9%）患者中。LPD 用于 18 例良性和 139 例恶性病变。肠系膜上静脉和/或门静脉受累需行主要静脉切除 8 例。90 天死亡率为 5.0%。胰腺导管腺癌的中位总生存期为 22.5 个月。
LPD 的发病率和死亡率与文献中的开腹手术相当。腹腔镜下主要静脉切除是可行和安全的。
