背景:腹腔镜胰十二指肠切除术(LPD)合并门静脉-肠系膜上静脉(PV/SMV)切除和重建越来越多。我们旨在介绍一种安全有效的手术方法,并分享我们的LPD与PV/SMV切除和重建的临床经验。
方法:我们回顾了2021年4月至2023年5月在吉林大学第一医院接受LPD和开放胰十二指肠切除术(OPD)联合PV/SMV切除和重建的患者的数据。采用后下“肠系膜上动脉优先”入路。我们比较了术前,术中,并对2组患者的术后临床病理资料进行LPD伴大血管切除综合评价。
结果:37例壶腹周围和胰腺肿瘤患者行胰十二指肠切除术(PD)合并大血管切除和重建,由21个LPDs和16个OPDs组成。LPD组手术时间较长(322vs.235分钟,P=0.039),术中出血减少(152vs.325mL,P=0.026),术中输血率较低(19.0%vs.50.0%,P=0.046)与OPD组比较。LPD组的端到端吻合手术时间明显缩短(26vs.15分钟,P=0.001)和人工移植物血管重建(44vs.22分钟,P=0.000)与OPD组比较。R0切除率无显著差异(100%vs.87.5%,P=0.096)。住院时间和ICU住院时间在两组之间没有显着差异(15vs.18d,P=0.636和2.5vs.4.5d,分别为P=0.726)。然而,与OPD组相比,LPD组的术后住院时间明显缩短(11vs.16d,P=0.007)。术后并发症发生率,包括术后胰瘘(POPF)A/B级,胆漏,和胃排空延迟(DGE),两组之间相似(38.1%vs.43.8%,P=0.729)。此外,每组1例患者发生血栓形成,抗凝治疗后血管通畅性改善。
结论:在静脉侵犯的情况下,LPD联合PV/SMV切除和重建可以使用下后“肠系膜上动脉优先”入路轻松安全地进行。需要进一步的研究来评估手术的长期结果。
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) with portal-superior mesenteric vein (PV/SMV) resection and reconstruction is increasingly performed. We aimed to introduce a safe and effective surgical approach and share our clinical experience with LPD with PV/SMV resection and reconstruction.
METHODS: We reviewed data for the patients undergoing LPD and open pancreaticoduodenectomy (OPD) combined with PV/SMV resection and reconstruction at the First Hospital of Jilin University between April 2021 and May 2023. The inferior-posterior \"superior mesenteric artery-first\" approach was used. We compared the preoperative, intraoperative, and postoperative clinicopathological data of the 2 groups to conduct a comprehensive evaluation of LPD with major vascular resection.
RESULTS: A cohort of 37 patients with periampullary and pancreatic tumors underwent pancreaticoduodenectomy (PD) with major vascular resection and reconstruction, consisting of 21 LPDs and 16 OPDs. The LPD group had a longer operation time (322 vs. 235 min, P =0.039), reduced intraoperative bleeding (152 vs. 325 mL, P =0.026), and lower intraoperative blood transfusion rates (19.0% vs. 50.0%, P =0.046) compared with the OPD group. The LPD group had significantly shorter operation times in end-to-end anastomosis (26 vs. 15 min, P =0.001) and artificial grafts vascular reconstruction (44 vs. 22 min, P =0.000) compared with the OPD group. There was no significant difference in the rate of R0 resection (100% vs. 87.5%, P =0.096). The length of hospital stay and ICU stay did not show significant differences between the 2 groups (15 vs. 18 d, P =0.636 and 2.5 vs. 4.5 d, P =0.726, respectively). However, the postoperative hospital stay in the LPD group was notably shorter compared with the OPD group (11 vs. 16 d, P =0.007). Postoperative complication rates, including postoperative pancreatic fistula (POPF) Grade A/B, biliary leakage, and delayed gastric emptying (DGE), were similar between the two groups (38.1% vs. 43.8%, P =0.729). In addition, 1 patient in each group developed thrombosis, with vascular patency improving after anticoagulation treatment.
CONCLUSIONS: LPD combined with PV/SMV resection and reconstruction can be easily and safely performed using the inferior-posterior \"superior mesenteric artery-first\" approach in cases of venous invasion. Further studies are required to evaluate the procedure\'s long-term outcomes.