摘要
目的:探讨腹腔镜下根治性顺行模块化胰脾切除术(laparoscopic radical antegrade modular pancreatosplenectomy,Lap-RAMPS)治疗胰体尾恶性肿瘤的适应证、可行性、安全性及临床疗效。方法:回顾分析2016年2月至2018年5月为6例患者行Lap-RAMPS的临床资料。结果:手术均顺利完成,无一例中转开腹;手术时间285(200～410) min,手术出血量142(50～300) m L,均获得R0切除;术后发生胰生化漏3例,胃排空障碍2例,不全性肠梗阻1例,均保守治疗痊愈。术后住院15.2(8～31) d,术后进食时间5(3～10) d,术后5.3(3～11) d排气,无再次手术病例。肿瘤最大径5.7(5～8) cm,病理示导管腺癌3例,其中高分化1例,低分化2例;高分化神经内分泌瘤、腺泡细胞癌、胰腺导管内乳头黏液性癌各1例。T_2期5例,T_3期1例; TNM分期(AJCC 7th)Ⅰ_B期4例、Ⅱ_A期1例、Ⅱ_B期1例。淋巴结清扫17.2(11～22)枚,淋巴结阳性1例(16.7%)。术后4例接受辅助化疗。6例患者均获得随访,1例于术后6个月发现肝内、腹腔网膜转移,继续静脉化疗; 1例于术后5个月发现术区复发,腹腔网膜及肝内多发转移,术后7个月死于肿瘤复发,余者均无瘤存活。结论:胰体尾恶性肿瘤患者行Lap-RAMPS安全、可行,可扩大手术适应证,短期效果满意,长期效果仍待进一步观察。
Objective:To investigate the indications,feasibility,safety and efficacy of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS)in the treatment of malignant tumors of the body and tail of the pancreas.Methods:The clinical data of 6 patients who underwent Lap-RAMPS in Hunan People's Hospital from Feb.2016 to May 2018 were retrospectively analyzed.Results:No conversion to laparotomy occurred,and operative time was 285 min(200-410 min),blood loss was 142 mL(50-300 mL)and the R0 resection rate was 100%.6 cases of complications,including pancreatic biochemical leakage in 3 cases,gastric empty delay in 2 cases and incomplete intestinal obstruction in 1 case,were cured by conservative treatment;postoperative hospitalization time was 15.2 d(8-31 d),postoperative feeding time was 5 d(3-10 d),flatus time was 5.3 d(3-11 d),there was no reoperation cases.The maximum diameter of tumor was 5.7 cm(5-8 cm).3 cases were pancreatic ductal adenocarcinoma,of which one was highly differentiated and two were poor-differentiated.There were 1 case of highly differentiated neuroendocrine tumor,1 case of acinar cell carcinoma and 1 case of intraductal papillary mucinous carcinoma of the pancreas.There were 5 cases in T 2 stage and 1 case in T 3 stage.TNM stage(AJCC 7th)were 4 cases ofⅠB stage,1 case ofⅡA stage and 1 case ofⅡB stage.The number of lymph node dissection was 17.2(11-22),and the number of positive lymph node was 1(16.7%).4 cases received adjuvant chemotherapy.Six patients were followed up until now.One patient found intrahepatic and abdominal omentum metastasis 6 months after operation and received intravenous chemotherapy.One patient found recurrence in the operation area 5 months after operation and multiple metastasis in the peritoneal omentum and liver.He died of tumor recurrence at 7 months after operation.The rest were alive without tumor recurrence.Conclusions:Lap-RAMPS is safe and feasible for patients with malignant tumors of the body and tail of the pancreas.The operative indication of the disease can be enlarged.The short-term outcome is promising while the long-term outcome needs more research.
作者
成伟
滕雄
曾诗语
朱朝庚
李国光
黄生桃
陈梅福
尹新民
彭创
蒋波
CHENG Wei;TENG Xiong;ZENG Shi-yu(Department of Hepatobiliary Surgery,Hunan Provincial People s Hospital(The First-affiliated Hospital of Hunan Normal University),Changsha 410005,China)
出处
《腹腔镜外科杂志》
2018年第9期689-693,共5页
Journal of Laparoscopic Surgery
关键词
胰体尾肿瘤
根治性顺行模块化胰脾切除术
腹腔镜检查
治疗结果
Pancreatic body/tail cancer
Radical antegrade modular pancreatosplenectomy
Laparoscopy
Treatment outcome
作者简介
成伟(1978—)男,湖南省人民医院胰脾外科主任,副主任医师,主要从事肝胆胰脾外科的研究;通讯作者:陈梅福,E-mail:chen_meifu@126.com。
