胰头肿瘤精准剜除的技术革新与术后胰瘘防控策略

doi:10.16139/j.1007-9610.2025.06.06

摘要/Abstract

摘要：

胰头良性和低度恶性肿瘤具有独特的临床病理特征，以及相对惰性的生物学行为，预后良好，手术治愈率高。剜除术在符合指征的情况下可以最小的创伤换取最大的胰腺功能保留，显现出良好的应用前景。本文聚焦于胰头肿瘤剜除的技术进展与术后胰瘘(POPF)防控策略，系统阐述该领域的前沿理念与临床实践。在精准外科和微创技术不断发展的背景下，剜除术作为保留胰腺功能的重要术式，其适应证选择、术中操作与围术期管理均面临诸多挑战。内容涵盖术前多模态影像评估与三维重建定位、术中超声及荧光导航的应用、不同手术入路（如腹侧、背侧及后腹腔镜入路）的比较与选择、机器人及腹腔镜等微创技术的优劣势分析，以及术后胰瘘的主动预防与处理策略。最后强调多学科协作与个体化决策在治疗中的核心作用，以期为提高手术安全性、降低并发症及改善病人预后提供实用参考。

关键词: 胰头肿瘤, 剜除术, 微创手术, 胰瘘, 精准治疗

Abstract:

Benign and low-grade malignant tumors of the pancreatic head have distinct clinicopathological features and a relatively indolent biological behavior, leading to favorable prognoses and high surgical cure rates. When indicated, enucleation enables maximal preservation of pancreatic function with minimal trauma, demonstrating considerable clinical promise. This article focused on recent technical advances in enucleation for pancreatic head tumors and postoperative pancreatic fistula (POPF) prevention strategies, offering a systematic review of current concepts and clinical practices in the field. In the context of advancing precision surgery and minimally invasive techniques, enucleation—as a pancreatic function-preserving procedure—continues to present challenges in indication selection, intraoperative technique, and perioperative management. Covered topics included preoperative multimodal imaging and three-dimensional reconstruction for tumor localization, the application of intraoperative ultrasound and fluorescence navigation, comparison and selection of surgical approaches (such as anterior, posterior, and retroperitoneal laparoscopic routes), and the advantages and limitations of minimally invasive techniques including robotic and laparoscopic surgery. Proactive strategies for POPF prevention and management were also discussed. Finally, the importance of multidisciplinary collaboration and individualized decision-making was emphasized, with the goal of improving surgical safety, reducing complications, and enhancing patient prognosis.

Key words: Pancreatic head tumor, Enucleation, Minimally invasive surgery, Pancreatic fistula, Precise treatment

中图分类号:

R735.9

杨峰, 徐业成, 傅德良. 胰头肿瘤精准剜除的技术革新与术后胰瘘防控策略[J]. 外科理论与实践, 2025, 30(06): 488-493.

YANG Feng, XU Yecheng, FU Deliang. Technical innovation in precise enucleation of pancreatic head tumors and postoperative pancreatic fistula prevention strategies[J]. Journal of Surgery Concepts & Practice, 2025, 30(06): 488-493.

图/表 3

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