Chen Ke, Pan Yu, Mou Yi-Ping, Wang Guan-Yu, Zhang Ren-Chao, Yan Jia-Fei, Jin Wei-Wei, Zhang Miao-Zun, Chen Qi-Long, Wang Xian-Fa
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.
J Laparoendosc Adv Surg Tech A. 2019 Sep;29(9):1085-1092. doi: 10.1089/lap.2018.0737. Epub 2019 Jul 22.
Laparoscopic pancreatectomy (LP) is increasingly performed with several institutional series and comparative studies reported. We have applied LP to a variety of pancreatic resections since 2004. This article is to report results of 15-year practice of 605 LPs for pancreatic and periampullary diseases. Patients with benign or malignant diseases in the pancreas and periampullary region, who underwent LP from June 2004 to June 2018, were retrospectively reviewed. The demographics and indications, and intraoperative and perioperative outcomes were evaluated. A total of 605 consecutive LPs were analyzed, including 237 (39.2%) distal pancreatectomy with splenectomy (DPS), 116 (19.2%) spleen-preserving distal pancreatectomy (SPDP), 30 (5.0%) enucleation (EN), 30 (5.0%) central pancreatectomy (CP), 186 (30.7%) pancreatoduodenectomy (PD), and 6 (1.0%) pancreatoduodenectomy with total pancreatectomy (PDTP). The most common pathologic finding was pancreatic ductal adenocarcinomas (146, 24.1%). Conversion to open procedure was required in 22 patients (3.6%) (12 with PD, 8 with DPS, 1 with CP, and 1 with PDTP). The mean operative time was 241.5 ± 105.5 minutes (range 50-550 minutes) for the entire population and 367.1 ± 61.8 minutes (range 230-550 minutes) for PD. Clinically significant pancreatic fistula (ISGPF grade B and C) rate was 12.4% for the entire cohort and 16.1% for PD. Rate of Clavien-Dindo III-V complications was 17.4% for the entire cohort and 23.7% for PD. Ninety-day mortality was observed only in the cohort of patients undergoing PD ( = 4). The LP procedure appears to be technically safe and feasible, with an acceptable rate of morbidity when performed at our experienced, high-volume center. However, PD has less favorable outcomes and needs further evaluation.
随着多个机构系列研究和比较研究的报道，腹腔镜胰腺切除术（LP）的开展越来越多。自2004年以来，我们已将LP应用于各种胰腺切除术。本文旨在报告605例LP治疗胰腺和壶腹周围疾病的15年实践结果。对2004年6月至2018年6月期间接受LP的胰腺和壶腹周围区域良性或恶性疾病患者进行回顾性分析。评估患者的人口统计学和适应证，以及术中及围手术期结果。共分析了605例连续的LP，包括237例（39.2%）胰体尾切除术联合脾切除术（DPS）、116例（19.2%）保留脾脏的胰体尾切除术（SPDP）、30例（5.0%）摘除术（EN）、30例（5.0%）中段胰腺切除术（CP）、186例（30.7%）胰十二指肠切除术（PD）和6例（1.0%）全胰十二指肠切除术（PDTP）。最常见的病理发现是胰腺导管腺癌（146例，24.1%）。22例患者（3.6%）需要转为开放手术（12例PD、8例DPS、1例CP和1例PDTP）。整组患者的平均手术时间为241.5±105.5分钟（范围50 - 550分钟），PD患者为367.1±61.8分钟（范围230 - 550分钟）。临床显著性胰瘘（ISGPF B级和C级）发生率在整个队列中为12.4%，在PD患者中为16.1%。Clavien-Dindo III - V级并发症发生率在整个队列中为17.4%，在PD患者中为23.7%。仅在接受PD的患者队列中观察到90天死亡率（=4）。在我们经验丰富、手术量大的中心进行LP手术，技术上似乎是安全可行的，发病率可接受。然而，PD的结果较差，需要进一步评估。
