保留功能的腹腔镜胰头部及十二指肠乳头肿瘤切除手术

doi:10.16139/j.1007-9610.2023.03.003

摘要/Abstract

摘要：

近年来，随着微创器械、设备的发展和手术技术的进步，胰腺微创外科进入快速发展阶段。包括腹腔镜保留十二指肠的胰头切除术、腹腔镜胰头部肿瘤局部剜除术以及腹腔镜十二指肠乳头局部切除术等保留功能的腹腔镜胰头部及十二指肠乳头肿瘤切除手术也得到逐步开展。但这些术式技术难度大、解剖复杂，很多外科医师缺乏相应的治疗经验，目前开展较少，尚未普及。本文探讨保留功能的腹腔镜胰头部及十二指肠乳头肿瘤切除手术的发展现状及相关技术问题，以提出相应对策，便于技术推广和发展。

关键词: 保留功能, 腹腔镜手术, 胰头部肿瘤, 十二指肠乳头肿瘤

Abstract:

In recent years, with the development of minimally invasive instruments,equipment and the progress of surgical techniques, minimally invasive pancreatic surgery has entered an era of rapid development. Function-preserving laparoscopic resection of pancreatic head and duodenal papilla tumors including laparoscopic duodenum-preserving pancreatic head resection (LDPPHR), laparoscopic pancreatic head tumor enucleation and laparoscopic transduodenal ampullary resection(LTDAR) have also been used in clinical practice. However, the anatomy and surgical procedures are extremely complicated. Many surgeons lack the experience in this field. So far, these procedures have rarely used in clinical practice. In this article, we introduced the current status, problems and countermeasures of these surgical procedures, to promote the development of function-preserving laparoscopic pancreatic head and duodenal papilla tumor resection surgery.

Key words: Function-preserving, Laparoscopic surgery, Pancreatic head tumor, Duodenal papilla tumor

中图分类号:

高攀, 蔡云强, 彭兵. 保留功能的腹腔镜胰头部及十二指肠乳头肿瘤切除手术[J]. 外科理论与实践, 2023, 28(03): 190-196.

GAO Pan, CAI Yunqiang, PENG Bing. Function-preserving laparoscopic resection of pancreatic head and duodenal papilla tumors[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 190-196.

图/表 1

参考文献 45

[1]	WANG M, PENG B, LIU J, et al. Practice patterns and perioperative outcomes of laparoscopic pancreaticoduodenectomy in China: a retrospective multicenter analysis of 1029 patients[J]. Ann Surg, 2021, 273(1):145-153. doi: 10.1097/SLA.0000000000003190 URL
[2]	FENG Q, LIAO W, XIN Z, et al. Laparoscopic pancreaticoduodenectomy versus conventional open approach for patients with pancreatic duct adenocarcinoma: an up-to-date systematic review and meta-analysis[J]. Front Oncol, 2021, 11:749140. doi: 10.3389/fonc.2021.749140 URL
[3]	BEGER H G, KUNZ R, POCH B. The Beger procedure duodenum-preserving pancreatic head resection[J]. J Gastrointest Surg, 2004, 8(8):1090-1097. doi: 10.1016/j.gassur.2003.12.001 URL
[4]	BEGER H G, NAKAO A, MAYER B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors-systematic review and meta-analysis[J]. Pancreatology, 2015, 15(2):167-178. doi: 10.1016/j.pan.2015.01.009 URL
[5]	罗涛, 蔡云强, 彭兵. 腹腔镜保留十二指肠全胰头切除术治疗胰头实性假乳头状肿瘤的临床体会(附4例报告)[J]. 腹腔镜外科杂志, 2020, 25(2):100-103.
	LUO T, CAI Y Q, PENG B. Laparoscopic duodenum-preserving pancreatic head resection for solid pseudopa-pillary tumor located at the pancreatic head:with a report of 4 cases[J]. J Laparosc Surg, 2020, 25(2):100-103.
[6]	TAKADA T, YASUDA H, UCHIYAMA K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity[J]. Hepatogastroenterology, 1993, 40(4):356-359.
[7]	CHEN S, GAO P, CAI H, et al. Indocyanine green-enhanced fluorescence in laparoscopic duodenum-preserving pancreatic head resection: technique with video[J]. Ann Surg Oncol, 2020, 27(10):3926-3927. doi: 10.1245/s10434-020-08360-6
[8]	CAI Y, ZHENG Z, GAO P, et al. Laparoscopic duodenum-preserving total pancreatic head resection using real-time indocyanine green fluorescence imaging[J]. Surg Endosc, 2021, 35(3):1355-1361. doi: 10.1007/s00464-020-07515-6
[9]	李伟男, 杨刚, 孙骥, 等. 腹腔镜技术在保留十二指肠胰头切除术中的应用(附视频)[J]. 中华肝脏外科手术学电子杂志, 2020, 9(5):493-496.
	LI W N, YANG G, SUN J, et al. The application of laparoscopic technique in duodenal pancreatic head preservation surgery (with videos)[J]. Chin J Hepat Surg(Electronic Edition), 2020, 9(5):493-496.
[10]	鲁超, 金巍巍, 牟一平, 等. 微创保留十二指肠的胰头切除术治疗胰头良性和交界性肿瘤的临床效果分析[J]. 中华外科杂志, 2022, 60(1):39-45.
	LU C, JIN W W, MOU Y P, et al. Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancrea-tic head[J]. Chin J Surg, 2022, 60(1):39-45.
[11]	武帅, 仵正. 微创保留十二指肠的胰头切除术的相关问题探讨[J]. 腹腔镜外科杂志, 2018, 23(9):657-660.
	WU S, WU Z. Discussion on the related issues of minimally invasive duodenum preserving pancreatic head resection[J]. J Laparosc Surg, 2018, 23(9):657-660.
[12]	刘学青, 梁云飞, 秦建章, 等. 腹腔镜保留十二指肠胰头切除术的应用价值[J]. 中华消化外科杂志, 2021, 20(4):445-450.
	LIU X Q, LIANG Y F, QIN J Z, et al. Application value of laparoscopic duodenum-preserving pancreatic head resection[J]. Chin J Dig Surg, 2021, 20(4):445-450.
[13]	GAGNER M, POMP A, HERRERA M F. Early expe-rience with laparoscopic resections of islet cell tumors[J]. Surgery, 1996, 120(6):1051-1054. doi: 10.1016/S0039-6060(96)80054-7 URL
[14]	DAMOLI I, BUTTURINI G, RAMERA M, et al. Minimally invasive pancreatic surgery-a review[J]. Wideochir Inne Tech Maloinwazyjne, 2015, 10(2):141-149.
[15]	EI S, MIHALJEVIC A L, KULU Y, et al. Enucleation for benign or borderline tumors of the pancreas: comparing open and minimally invasive surgery[J]. HPB (Oxford), 2021, 23(6):921-926. doi: 10.1016/j.hpb.2020.10.001 URL
[16]	FERNÁNDEZ-CRUZ L, MOLINA V, VALLEJOS R, et al. Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours[J]. HPB(Oxord), 2012, 14(3):171-176.
[17]	CRIPPA S, BONINSEGNA L, PARTELLI S, et al. Parenchyma-sparing resections for pancreatic neoplasms[J]. J Hepatobiliary Pancreat Sci, 2010, 17(6):782-787. doi: 10.1007/s00534-009-0224-1 URL
[18]	SUBAR D, GOBARDHAN P D, GAYET B. Laparoscopic pancreatic surgery: an overview of the literature and experiences of a single center[J]. Best Pract Res Clin Gastroenterol, 2014, 28(1):123-132. doi: 10.1016/j.bpg.2013.11.011 URL
[19]	DEDIEU A, RAULT A, COLLET D, et al. Laparoscopic enucleation of pancreatic neoplasm[J]. Surg Endosc, 2011, 25(2):572-576. doi: 10.1007/s00464-010-1223-7 URL
[20]	SONG K B, KIM S C, HWANG D W, et al. Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients[J]. Surgery, 2015, 158(5):1203-1210. doi: 10.1016/j.surg.2014.10.008 URL
[21]	BRIENT C, REGENET N, SULPICE L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation[J]. J Gastrointest Surg, 2012, 16(10):1883-1887. doi: 10.1007/s11605-012-1971-x URL
[22]	HEEGER K, FALCONI M, PARTELLI S, et al. Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors[J]. Langenbeck Arch Surg, 2014, 399(3):315-321. doi: 10.1007/s00423-014-1171-0 URL
[23]	RHEE H, PARK M S. The role of imaging in current treatment strategies for pancreatic adenocarcinoma[J]. Korean J Radiol, 2021, 21(1):23-40.
[24]	KITANO M, YOSHIDA T, ITONAGA M, et al. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer[J]. J Gastroenterol, 2019, 54(1):19-32. doi: 10.1007/s00535-018-1519-2
[25]	Gharios J, Hain E, Dohan A, et al. Pre- and intraoperative diagnostic requirements, benefits and risks of minimally invasive and robotic surgery for neuroendocrine tumors of the pancreas[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33(5):101294. doi: 10.1016/j.beem.2019.101294 URL
[26]	刘荣, 刘渠, 柳俨哲, 等. 胰腺外科新方向——胰管修复外科[J]. 解放军医学院学报, 2021, 42(6):591-595.
	LIU R, LIU Q, LIU Y Z, et al. Pancreatic duct reconstructive surgery: a new direction for pancreas surgery[J]. Acad J Chin PLA Med Sch, 2021, 42(6):591-595.
[27]	DI BENEDETTO F, MAGISTRI P, BALLARIN R, et al. Ultrasound- guided robotic enucleation of pancreatic neuroendocrine tumors[J]. Surg Innov, 2019, 26(1):37-45. doi: 10.1177/1553350618790711 URL
[28]	KIMURA W, MIYATA H, GOTOH M, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy[J]. Ann Surg, 2014, 259(4):773-780. doi: 10.1097/SLA.0000000000000263 URL
[29]	GROEN J V, SMITS F J, KOOLE D, et al. Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis[J]. Br J Surg, 2021, 108(11):1371-1379. doi: 10.1093/bjs/znab273 URL
[30]	BEGER H G, POCH B, MAYER B, et al. New onset of diabetes and pancreatic exocrine insufficiency after pancreaticoduodenectomy for benign and malignant tumors: a systematic review and meta- analysis of long-term results[J]. Ann Surg, 2018, 267(2):259-270. doi: 10.1097/SLA.0000000000002422 URL
[31]	GAO Y, ZHU Y, HUANG X, et al. Transduodenal ampullectomy provides a less invasive technique to cure early ampullary cancer[J]. BMC Surg, 2016, 16(1):36. doi: 10.1186/s12893-016-0156-z URL
[32]	ROSEN M, ZUCCARO G, BRODY F. Laparoscopic resection of a periampullary villous adenoma[J]. Surg Endosc, 2003, 17(8):1322-1323.
[33]	HONDA G, KURATA M, MATSUMURA H, et al. Laparoscopy-assisted transduodenal papillectomy[J]. Dig Surg, 2010, 27(2):123-126. doi: 10.1159/000289056 URL
[34]	WAKABAYASHI T, KITAGO M, KITAGAWA Y. Laparoscopy-assisted transduodenal papillectomy: how we do it (with video)[J]. Langenbecks Arch Surg, 2021, 406(8):2887-2890. doi: 10.1007/s00423-021-02289-4
[35]	CAI H, GAO P, LU F, et al. Laparoscopic transduodenal ampullectomy: how we have standardized the technique (with video)[J]. Ann Surg Oncol, 2023, 30(2):1156-1157. doi: 10.1245/s10434-022-12867-5
[36]	EL HAJJ II, COTÉ G A. Endoscopic diagnosis and mana-gement of ampullary lesion[J]. Gastrointest Endosc Clin N Am, 2013, 23(1):95-109. doi: 10.1016/j.giec.2012.10.004 URL
[37]	HEIDECKE C D, ROSENBERG R, BAUER M, et al. Impact of grade of dysplasia in villous adenomas of Vater's papilla[J]. World J Surg, 2002, 26(6):709-714. doi: 10.1007/s00268-002-6215-x URL
[38]	FANNING S B, BOURKE M J, WILLIAMS S J, et al. Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats[J]. Gastrointest Endosc, 2012, 75(4):805-812. doi: 10.1016/j.gie.2011.11.038 URL
[39]	DUBOIS M, LABGAA I, DORTA G, et al. Endoscopic and surgical ampullectomy for non-invasive ampullary tumors: short-term outcomes[J]. Biosci Trends, 2017, 10(6):507-511. doi: 10.5582/bst.2016.01193 URL
[40]	HAREWOOD G C, POCHRON N L, GOSTOUT C J. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla[J]. Gastrointest Endosc, 2005, 62(3):367-370. doi: 10.1016/j.gie.2005.04.020 URL
[41]	KAHALEH M, SHAMI V M, BROCK A, et al. Factors predictive of malignancy and endoscopic resectability in ampullary neoplasia[J]. Am J Gastroenterol, 2004, 99(12):2335. doi: 10.1111/ajg.2004.99.issue-12 URL
[42]	ONKENDI E O, NAIK N D, ROSEDAHL J K, et al. Adenomas of the ampulla of vater: a comparison of outcomes of operative and endoscopic resections[J]. J Gastrointest Surg, 2014, 18(9):1588-1596.. doi: 10.1007/s11605-014-2543-z URL
[43]	RIDTITID W, SCHMIDT S E, AL-HADDAD M A, et al. Performance characteristics of EUS for locoregional evaluation of ampullary lesions[J]. Gastrointest Endosc, 2015, 81(2):380-388. doi: 10.1016/j.gie.2014.08.005 URL
[44]	PENG C Y, LV Y, SHEN S S, et al. The impact of endoscopic ultrasound in preoperative evaluation for ampullary adenomas[J]. J Dig Dis, 2019, 20(5):248-255. doi: 10.1111/cdd.2019.20.issue-5 URL
[45]	TSUJI S, ITOI T, SOFUNI A, et al. Tips and tricks in endoscopic papillectomy of ampullary tumors: single-center experience with large case series (with videos)[J]. J Hepatobiliary Pancreat Sci, 2015, 22(6):E22-E27. doi: 10.1002/jhbp.v22.6 URL