3D腹腔镜根治性顺行模块化胰脾切除术的临床疗效（附22例报告）

Clinical efficacy of 3D laparoscopic radical antegrade modular pancreaticosplenectomy (22 cases)

摘要:

目的 探讨3D腹腔镜根治性顺行模块化胰脾切除术（LRAMPS）治疗胰体尾癌的临床疗效。方法 回顾性分析2023年1月－2024年12月于该院行3D LRAMPS的22例患者的临床资料，统计手术时间、术中出血量、术后第一次下床时间、住院时间、术后排气时间、术后并发症、病理类型、随访情况和复发情况。结果 所有患者均在3D腹腔镜下成功完成手术。手术时间（263.6±20.5）min，术中出血量（100.4±30.5）mL，术后第一次下床时间（1.5±0.5）d，住院时间（8.5±2.1）d，术后排气时间（2.5±1.0）d。手术后发生A级胰瘘10例，B级胰瘘6例（给予充分引流抗感染等治疗后，均痊愈出院），无C级胰瘘发生。无术后大出血和围手术期死亡等情况发生。术后病理报告显示：胰腺导管腺癌17例，胰腺囊腺癌3例，神经内分泌癌2例。所有患者均获得R0切除，清扫淋巴结（15.1±4.3）枚，8例患者淋巴结检查阳性，阳性率为36.4%。术后随访4～19个月，中位随访时间12（5.5，16.5）个月，复发2例。结论 3D LRAMPS治疗胰体尾癌，是一种安全、有效和微创的治疗方法，腹腔镜手术经验丰富的医院可尝试开展。

Abstract:

Objective To explore the clinical efficacy of 3D laparoscopic radical anterograde modular pancreaticosplenectomy (LRAMPS) in the treatment of pancreatic body and tail cancer.Methods A retrospective analysis was conducted on the clinical data of 22 patients who underwent 3D LRAMPS from January 2023 to December 2024. The operation time, intraoperative blood loss, time to get out of bed for the first time after surgery, hospital stay, postoperative exhaust time, postoperative complications, pathological types, follow-up situation and recurrence situation were statistically analyzed.Results All patients successfully completed the surgery under 3D laparoscopy. The operation time was (263.6 ± 20.5) min, the intraoperative blood loss was (100.4 ± 30.5) mL, the first time to get out of bed after the operation was (1.5 ± 0.5) d, the hospital stay was (8.5 ± 2.1) d, and the postoperative exhaust time was (2.5 ± 1.0) d. There were 10 cases of grade A pancreatic fistula and 6 cases of grade B pancreatic fistula after the operation (all recovered and were discharged after adequate drainage, anti-infection and other treatments), and no grade C pancreatic fistula occurred. There were no cases of postoperative massive hemorrhage or perioperative death. Postoperative pathological reports showed that there were 17 cases of pancreatic ductal adenocarcinoma, 3 cases of pancreatic cystadenocarcinoma, and 2 cases of neuroendocrine carcinoma. All patients underwent R0 resection, and (15.1 ± 4.3) lymph nodes were dissected. Lymph node examinations were positive in 8 patients, with a positive rate of 36.4%. The postoperative follow-up period ranged from 4～19 months, with a median follow-up time of 12 (5.5, 16.5) months. There were 2 cases of recurrence.Conclusion 3D LRAMPS for pancreatic body and tail cancer is a safe, effective and minimally invasive treatment method. Hospitals with rich experience in laparoscopic surgery can try to carry it out.