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目的:总结3D腹腔镜胰十二指肠切除治疗壶腹周围癌的经验与临床疗效。方法:回顾性分析2014年1月—2017年3月101例在湖南省人民医院肝胆外科行3D腹腔镜胰十二指肠切除术的壶腹周围癌101例患者的临床资料。结果:全组平均手术时间为325.7(220~575)min,术中出血为175.9(100~550)mL。术后并发症包括胰瘘23例(22.8%),其中生化瘘17例(16.8%)、B级胰瘘5例(5.0%)、C级胰瘘1例(1.0%),术后出血7例(6.9%),术后胆汁漏2例(3.0%),胃排空延迟4例(4.0%),腹腔感染6例(5.9%),肺部感染3例(3.0%),肠梗阻2例(2.0%);Clavien并发症分级III级以上患者9例(8.9%),其中3例患者行再次手术;住院30 d内死亡患者1例(1.0%);术后平均住院时间14.8(8~29)d;术后病理为胆总管下端癌27例(26.7%)、壶腹部癌23例(22.8%)、十二指肠乳头癌39例(38.6%)、胰腺导管腺癌12例(11.9%),肿瘤直径(2.3±1.3)cm,R_0切除率95.0%,淋巴结清扫数目为(16.7±4.2)枚,其中阳性淋巴结为(1.3±1.1)枚。结论:3D腹腔镜胰十二指肠切除治疗壶腹周围癌安全可行,近期疗效良好。
Objective: To summarize the experience and clinical efficacy of 3D laparoscopic pancreatoduodenectomy in the treatment of periampullary carcinoma. Methods: The clinical data of 101 patients with periampullary carcinoma underwent 3D laparoscopic pancreatoduodenectomy from January 2014 to March 2017 in Hunan Provincial People’s Hospital were retrospectively analyzed. Results: The average operation time was 325.7 (220-575) min and the intraoperative bleeding was 175.9 (100-550) mL. Postoperative complications included 23 cases of pancreatic fistula (22.8%), including 17 cases of biochemical fistula (16.8%), 5 cases of grade B pancreatic fistula (5.0%), 1 case of grade C pancreatic fistula (1.0%), (6.9%), postoperative bile leakage in 2 (3.0%), delayed gastric emptying in 4 (4.0%), abdominal infection in 6 (5.9%), pulmonary infection in 3 (3.0% (2.0%); 9 patients (8.9%) had Clavien’s complication grade III or higher, 3 patients underwent reoperation; 1 patient died within 30 days after hospitalization (1.0%); average postoperative hospital stay was 14.8 ~ 29) d. The pathology of the lower end of common bile duct was 27 cases (26.7%), ampullary carcinoma in 23 cases (22.8%), duodenal papillary carcinoma in 39 cases (38.6%), pancreatic ductal adenocarcinoma in 12 cases 11.9%). The diameter of the tumor was (2.3 ± 1.3) cm. The resection rate of R0 was 95.0%. The number of lymph node dissection was (16.7 ± 4.2) pieces, and the positive lymph node was (1.3 ± 1.1) pieces. Conclusion: 3D laparoscopic pancreatoduodenectomy for the treatment of periampullary carcinoma safe and feasible, the recent good effect.