湖南省湘西土家族苗族自治州人民医院 肝胆外科，湖南 吉首 416000
Department of Hepatobiliary Surgery, the People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou, Hunan 416000, China
背景与目的 保留十二指肠全胰头切除术（DPPHR）胰头良性或低恶性占位病常见的术式选择，尽管腹腔镜胰腺手术已日趋成熟，但传统腹腔镜下进行该手术仍有相当大的难度。近年来，3D腹腔镜技术的出现，克服了传统腹腔镜的短板，使得腹腔镜手术更精细、更安全。本研究总结4例荧光显影引导的3D腹腔镜下行DPPHR的经验，以期为该术式的应用与推广提供参考。方法 回顾性分析湖南省湘西土家族苗族自治州人民医院肝胆外科2019年8月—2021年5月4例行荧光显影导航下3D腹腔镜DPPHR的患者临床资料。结果 4例患者均成功实施荧光导航下3D腹腔镜DPPHR，手术时间370~510 min；出血量80~300 mL；均未输注红细胞和血浆。术后1例患者发生迟发性胃排空障碍，经留置鼻空肠营养管等措施后治愈，2例患者发生A级生化漏，无十二指肠穿孔、胆汁漏、出血、二次手术等并发症发生。4例患者术后随访3~24个月，均恢复良好。结论 选择合适病例，在经验较丰富的胰腺外科中心开展荧光导航下3D腹腔镜DPPHR是安全可行的。
Background and Aims Duodenum-preserving pancreatic head resection (DPPHR) is a commonly used option for benign or low-grade malignant space-occupying lesions of the head of the pancreas. Despite advances in laparoscopic techniques, performing this procedure under traditional laparoscopic approaches is still considerably challenging. In recent years, the emergence of 3D laparoscopic techniques overcomes the shortcomings of traditional laparoscopic methods and makes laparoscopic surgery more precise and safer. Here, the authors summarize the experience in 4 cases undergoing 3D laparoscopic DPPHR guided by fluorescence imaging, so as to provide a reference for the application and promotion of this technique.Methods The clinical data of 4 patients who underwent 3D laparoscopic laparoscopic DPPHR under fluorescence imaging navigation from August 2019 to May 2021 in the People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture were analyzed retrospectively.Results The 3D laparoscopic DPPHR under fluorescence imaging navigation was successfully completed in all 4 patients. The operative time was 370-510 min, and the blood loss was 80-300 mL, with no transfusion requirements of red blood cells and plasma. After the operation, one patient developed delayed gastric emptying, which was resolved by inserting a nasojejunal nutrition tube, 2 patients developed grade A biochemical leakage, and there were no complications such as duodenal perforation, postoperative bile leakage, postoperative bleeding, and secondary operation. All 4 patients were followed up for 3-24 months and recovered well.Conclusion Performing 3D laparoscopic DPPHR guided by fluorescence imaging is safe and feasible with the appropriate selection of patients in an experienced pancreatic surgery center.