荧光显影导航3D腹腔镜保留十二指肠全胰头切除术4例报告(附视频)
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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

作者简介:

王文儿,湖南省湘西土家族苗族自治州人民医院主任医师,主要从事肝胆胰外科疾病临床方面的研究。

通信作者:

宋新,Email: 13974310132@163.com

基金项目:

湖南省卫健委科研计划基金资助项目(20200742)。


A report of 4 cases of 3D laparoscopic duodenum-preserving pancreatic head resection under fluorescence imaging navigation (with video)
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Affiliation:

Department of Hepatobiliary Surgery, the People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou, Hunan 416000, China

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    摘要:

    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。

    Abstract:

    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.

    表 1 患者术前临床资料Table 1 Preoperative clinical data of the patients
    Fig.
    图1 术中照片 A:离断右侧份胃结肠韧带;B:显露胰头、胰颈腹侧面;C:解剖胃十二指肠动脉;D:悬吊胃窦部;E:显露胰腺下缘SMV;F:术中超声确认病变位置;G:离断胰腺颈部;H:悬吊胰颈后方的PV和SMV;I:显露胆总管;J:向肝门方向显露出胆总管胰腺段全程;K:胆管内的荧光为导航,帮助辨识和保护该段胆总管;L:离断胰十二指肠上后血管发往胰头的分支;M:离断主胰管;N:检查术野;O:胰肠吻合;P:空肠-空肠侧侧吻合Fig.1 Intraoperative views A: Division of the right part of gastrocolic ligament; B:Exposure of the ventral side of the head and neck of the pancreas; C: Dissection of the gastroduodenal artery; D: Suspending the gastric antrum; E: Exposure of the SMV at the inferior margin of the pancreas; F: Identification of the lesion location by intraoperative ultrasound; G: Division of the neck of the pancreas; H: Suspending the PV and SMV behind the neck of the pancreas; I: Exposure of the common bile duct; J: Exposure of the whole running course of the common bile duct within the pancreas towards the direction of hepatic portal; K: Identification and protection of this segment of the common bile duct assisted by the guidance of biliary fluorescence imaging; L: Division of the branches from the posterosuperior pancreaticoduodenal vessels to the head of the pancreas; M: Division of the main pancreatic duct; N: Surgical field checking; O: Pancreaticojejunostomy; P: Side-to-side jejunojejunal anastomosis
    Fig.
    图1 术中照片 A:离断右侧份胃结肠韧带;B:显露胰头、胰颈腹侧面;C:解剖胃十二指肠动脉;D:悬吊胃窦部;E:显露胰腺下缘SMV;F:术中超声确认病变位置;G:离断胰腺颈部;H:悬吊胰颈后方的PV和SMV;I:显露胆总管;J:向肝门方向显露出胆总管胰腺段全程;K:胆管内的荧光为导航,帮助辨识和保护该段胆总管;L:离断胰十二指肠上后血管发往胰头的分支;M:离断主胰管;N:检查术野;O:胰肠吻合;P:空肠-空肠侧侧吻合Fig.1 Intraoperative views A: Division of the right part of gastrocolic ligament; B:Exposure of the ventral side of the head and neck of the pancreas; C: Dissection of the gastroduodenal artery; D: Suspending the gastric antrum; E: Exposure of the SMV at the inferior margin of the pancreas; F: Identification of the lesion location by intraoperative ultrasound; G: Division of the neck of the pancreas; H: Suspending the PV and SMV behind the neck of the pancreas; I: Exposure of the common bile duct; J: Exposure of the whole running course of the common bile duct within the pancreas towards the direction of hepatic portal; K: Identification and protection of this segment of the common bile duct assisted by the guidance of biliary fluorescence imaging; L: Division of the branches from the posterosuperior pancreaticoduodenal vessels to the head of the pancreas; M: Division of the main pancreatic duct; N: Surgical field checking; O: Pancreaticojejunostomy; P: Side-to-side jejunojejunal anastomosis
    表 2 患者术中术后情况Table 2 Intra- and postoperative conditions of the patients
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王文儿,宋新.荧光显影导航3D腹腔镜保留十二指肠全胰头切除术4例报告(附视频)[J].中国普通外科杂志,2022,31(9):1154-1161.
DOI:10.7659/j. issn.1005-6947.2022.09.004

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  • 收稿日期:2021-10-28
  • 最后修改日期:2022-02-25
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  • 在线发布日期: 2022-09-30