Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China.
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Surg Endosc. 2019 Feb;33(2):633-638. doi: 10.1007/s00464-018-6488-2. Epub 2018 Nov 19.
Duodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation.
From August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study.
There were ten women and two men. The average age was 37.3 years (range 8-61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2-4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210-320 min). The average blood loss was 215 ml (range 50-450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6-25 days).
LDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.
保留十二指肠的胰头全切除术（DPPHRt）通过保留十二指肠及其来自胰十二指肠动脉弓的完整血液供应，是治疗胰头良性或低度恶性肿瘤的一种可接受的替代手术方法。本研究描述了我们在腹腔镜下保留十二指肠的胰头全切除术（LDPPHRt）方面的经验。据我们所知，这是对这种新型微创手术的首次描述。
从 2016 年 8 月到 2017 年 5 月，在中国广州中山大学孙逸仙纪念医院肝胆外科，所有连续接受 LDPPHRt 治疗胰头病变的患者均被纳入本回顾性研究。
共有 10 名女性和 2 名男性。平均年龄为 37.3 岁（范围 8-61 岁）。术前 CT/MR 上胰头病变的平均直径为 3.7cm（范围 2-4.8cm）。所有 LDPPHRt 手术均成功完成。无围手术期死亡。平均手术时间为 272.5 分钟（范围 210-320 分钟）。平均出血量为 215ml（范围 50-450ml）。术后并发症包括胰瘘 B 级（两例，16.7%）和胆瘘（两例，16.7%）。所有并发症均经保守治疗后好转。术后平均住院时间为 11.5 天（范围 6-25 天）。
LDPPHRt 为胰头良性或低度恶性肿瘤提供了一种微创的保留器官的方法。该手术的长期肿瘤学结果以及术后外分泌和内分泌胰腺功能需要进一步研究。
