摘要
目的探讨电视腹腔镜胰十二指肠切除术的可行性,手术难点及手术适应证。方法分析我院2002年11月22日～2005年4月28日电视腹腔镜胰十二指肠切除术5例的临床资料。分析术前诊断、手术主要方法、步骤、术中出血量、手术时间、术中难点及对策,术后恢复情况及有关指标包括:体温、引流量、血常规、肝功能、胰淀粉的酶变化及术后并发症,肠道功能恢复情况,住院时间等。结果5例手术均成功,手术时间360～660min,平均528min。术中出血150～2000ml,平均770ml。病理类型:十二指肠乳头高分化腺癌3例,胰头内分泌小细胞癌1例,十二指肠乳头腺瘤样增生恶变,肝胆管中上段中分化腺癌1例。术后例1出现小量胰漏;例2出现消化道应激性溃疡出血,均经对症处理治愈;例4术后出现复发性胰腺炎合并肺部感染,术后39d出现应激性溃疡消化道出血再次手术死亡,术后体温例4胰腺炎复发后体温高达39.5℃,其余4例最高体温<38℃,术后引流量除例4外其余4例最多者术后第一天800ml,逐渐减少至100ml,持续5d。全部病例术后3d左右均恢复肠鸣,1周恢复进食。结论腹腔镜下胰十二指肠切除术是目前腔镜外科最复杂的高风险手术,需要有丰富的传统胰十二指肠切除的临床经验,熟练的腔镜外科操作技术,配合默契的手术团队,先进的腔镜设备,严格的手术适应证,在具备条件的医院及医生中进行该手术是安全、可行的。目前可选择适当的病例进行临床探讨。
Objective To explore the feasibility, difficulties and indications of video - assisted laparoscopic pancreaticoduodenectomy. Methods Clinical records of 5 cases of laparoscopic pancreaticoduodenectomy in this hospital from November 22, 2002 to April 28, 2005 were analyzed, with respect to preoperative diagnosis, surgical methods and procedures, intraoperative blood loss, operation time, difficulties encountered and countermeasures, and postoperative recovery. Related parameters included patient＇ s temperature, drainage volume, blood routine, liver functions, amylopsin changes, postoperative complications, bowel movement recovery, and length of hospital stay. Results All the 5 cases of operation were successfully performed, with an operation time of 360 -660 min （mean, 528 min） and an intraoperative blood loss of 150 -2 000 ml （mean, 770 ml）. Pathological examinations revealed 3 cases of well - differentiated papillary adenocarcinoma of the duodenum, 1 case of endocrine small - cell carcinoma of the head of pancreas, and 1 case of papillary adenomatoid hyperplasia of the duodenum with malignant changes accompanying intermediated - differentiated adenocarcinoma of upper and middle intrahepatic biliary duct. Postoperatively, a small amount of pancreatic leakage occurred in case number 1 and a digestive tract stress ulcer happened in case number 2, all of which were cured by symptomatic management. In case number 4, a recurrent pancreatitis with pulmonary infection was observed, and the patient died from stress ulcer hemorrhage on the 39th postoperative day. Except for the case number 4 in which the patient＇ s highest temperature reached 39.5 ℃ after the recurrence of pancreatitis, the highest temperatures of the other 4 patients were all 〈 38 ℃ Except for case number 4, the most postoperative drainage volume was 800 ml on the 1 st postoperative day and lasted for 5 days to a level of 100 ml per day. All the patients recovered bowel movement around the 3rd postoperative day and resumed taking foods within 1 week. Conclusions Laparoscopic pancreaticoduodenectomy is the most difficult and risky operation until now. It is safe and feasible by surgeons with rich proficiency in both traditional pancreaticoduodenectomy and laparoscopic surgery.
出处
《中国微创外科杂志》
CSCD
2005年第11期877-879,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
电视腹腔镜手术
胰十二指肠切除术
Video- assisted laparoscopic surgery
Pancreaticoduodenectomy
