背景:保留实质的胰腺切除术(PSP)或保留胰腺的十二指肠切除术(PSD)是胰头或十二指肠良性或低度恶性肿瘤患者的替代方法。它避免了保留胰腺功能的创伤性胰十二指肠切除术(PD),并提高了生活质量。然而,很少有研究报道机器人PSP(RPSP)或机器人PSD(RPSD)。
方法:回顾性分析2018年1月至2022年2月17例良性和低度恶性胰头和十二指肠肿瘤行RPSP或RPSD的患者。人口统计,围手术期,收集并分析所有患者的术后资料。
结果:17例患者手术均成功,无转换,其中RPSP10例,RPSD7例。对于RPSP,八名患者接受了胰腺摘除术,两名患者接受了钩突切除术。对于RPSD,五名患者接受了局部十二指肠切除术,两名患者接受了十二指肠切除术,同时进行五次空肠造口术和两次远端胃切除术。RPSP的OT和EBL中位数为135分钟和50mL,RPSD为220分钟和100mL,分别。RPSP的中位LOS为8天,RPSD为19天。RPSP的主要术后并发症包括POPF(B级,6例),DGE(B级,1例),PPH(1例),腹腔感染(1例)。RPSD的主要术后并发症包括DGE(B级,1例,C级,3例),术后出血(1例),腹腔感染(1例),十二指肠瘘1例。由于POPF,一名患者在RPSP后接受了介入引流。
结论:RPSP或RPSD对于高度选择性的良性和低度恶性胰头和十二指肠肿瘤患者是可行的,避免潜在的胰十二指肠切除术。
BACKGROUND: Parenchymal-sparing pancreatectomy (PSP) or pancreas-sparing
duodenectomy (PSD) is an alternative method for patients with benign or low-grade malignant tumours at the pancreatic head or duodenum. It avoids traumatic pancreaticoduodenectomy (PD) with pancreatic function preservation and improves quality of life. However, few studies have reported on robotic PSP (RPSP) or robotic PSD (RPSD).
METHODS: A retrospective analysis of 17 patients with benign and low-grade malignant pancreatic head and duodenal tumours who underwent RPSP or RPSD from January 2018 to February 2022 was conducted. The demographic, perioperative, and postoperative data of all patients were collected and analysed.
RESULTS: The operations were successful for all seventeen patients without conversion, including 10 cases of RPSP and 7 cases of RPSD. For RPSP, eight patients underwent pancreatic enucleation, and two patients underwent uncinate process resection. For RPSD, five patients underwent local
duodenectomy, and two patients underwent segmental
duodenectomy, with five simultaneous jejunostomies and two distal gastrectomies. The median OT and EBL were 135 min and 50 mL for RPSP and 220 min and 100 mL for RPSD, respectively. The median LOS was 8 days for RPSP and 19 days for RPSD. The main postoperative complications for RPSP included POPF (grade B, 6 cases), DGE (grade B, 1 case), PPH (1 case), and intra-abdominal infection (1 case). The main postoperative complications for RPSD included DGE (grade B, 1 case, grade C, 3 cases), postoperative haemorrhage (1 case), intra-abdominal infection (1 case), and duodenal fistula (1 case). One patient underwent interventional drain placement after RPSP because of POPF.
CONCLUSIONS: RPSP or RPSD is feasible for highly selected patients with benign and low-grade malignant pancreatic head and duodenal tumours, avoiding potential pancreaticoduodenectomy.