保留功能的腹腔镜胰腺手术：胰腺外科的合理选择

李澄清; 王磊

doi:10.3969/j.issn.1001-5256.2022.12.004

保留功能的腹腔镜胰腺手术：胰腺外科的合理选择

DOI: 10.3969/j.issn.1001-5256.2022.12.004

李澄清,
王磊^, ,

山东大学齐鲁医院胰腺外科，济南 250063

基金项目:

国家自然科学基金 (81900731)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：李澄清负责文章撰写及文献检索；王磊负责拟定写作思路，文章修改及最终定稿。

详细信息

通信作者:
王磊，qlwanglei1102@163.com

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出版历程
- 收稿日期: 2022-10-12
- 录用日期: 2022-11-12
- 出版日期: 2022-12-20

Function-preserving laparoscopic pancreatic surgery: A reasonable choice in pancreatic surgery

Chengqing LI,
Lei WANG^{,
,}

Department of Pancreatic Surgery, Qilu Hospital, Shandong University, Jinan 250063, China

Research funding:

National Natural Science Foundation of China (81900731)

More Information

Corresponding author: WANG Lei, qlwanglei1102@163.com (ORCID: 0000-0003-3887-6107)

摘要

摘要: 随着诊断技术的提高，胰腺肿瘤的检出率明显提高，且出现年轻化的趋势。作为重要的内外分泌器官，胰腺功能的丧失对患者生存质量将会产生严重影响。因此，创伤较小的腹腔镜保留功能的胰腺手术是治疗良性和低度恶性胰腺病变的理想方法，也是胰腺外科探索的方向。胰腺肿瘤剜除术、保留十二指肠的胰头切除术和保留脾脏的胰体尾切除术是目前临床上常用的保留功能胰腺术式。本文重点介绍了腹腔镜保留功能的常用术式并提供了一些手术技巧，帮助选择合理的胰腺术式，为患者制订胰腺手术的个体化决策。
- 胰腺肿瘤 /
- 腹腔镜 /
- 外科手术
Abstract: With the improvement of diagnostic techniques, the diagnostic rate of pancreatic tumors has increased significantly, with a tendency of an earlier age of onset. Since the pancreas is an important endocrine organ, the loss of pancreatic function will have a serious impact on the quality of life of patients. Therefore, function-preserving laparoscopic pancreatic surgery with little trauma is an ideal method for the treatment of benign and low-grade malignant pancreatic lesions and is also a direction for exploration in pancreatic surgery. Pancreatic tumor enucleation, duodenum-preserving pancreatic head resection, and spleen-preserving distal pancreatectomy are commonly used surgical procedures for preserving pancreatic function in clinical practice nowadays. This article introduces commonly used surgical procedures for function-preserving laparoscopic pancreatic surgery and provides some surgical skills to help choose a reasonable surgical procedure and make individualized decisions on pancreatic surgery for patients.
- Pancreatic Neoplasms /
- Laparoscopes /
- Surgical Procedures, Operative

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参考文献(33)

[1]	FALCONI M, BARTSCH DK, ERIKSSON B, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors[J]. Neuroendocrinology, 2012, 95(2): 120-134. DOI: 10.1159/000335587.
[2]	BEGER HG, MAYER B, VASILESCU C, et al. Long-term metabolic morbidity and steatohepatosis following standard pancreatic resections and parenchyma-sparing, local extirpations for benign tumor: A systematic review and meta-analysis[J]. Ann Surg, 2022, 275(1): 54-66. DOI: 10.1097/SLA.0000000000004757.
[3]	BEGER HG, MAYER B, RAU BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer—a systematic review[J]. J Gastrointest Surg, 2016, 20(1): 206-217. DOI: 10.1007/s11605-015-2981-2.
[4]	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.
[5]	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.
[6]	KONISHI T, TAKAMOTO T, FUJIOGI M, et al. Laparoscopic versus open distal pancreatectomy with or without splenectomy: A propensity score analysis in Japan[J]. Int J Surg, 2022, 104: 106765. DOI: 10.1016/j.ijsu.2022.106765.
[7]	BJÖRNSSON B, LARSSON AL, HJALMARSSON C, et al. Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial[J]. Br J Surg, 2020, 107(10): 1281-1288. DOI: 10.1002/bjs.11554.
[8]	van HILST J, de GRAAF N, ABU HILAL M, et al. The landmark series: Minimally invasive pancreatic resection[J]. Ann Surg Oncol, 2021, 28(3): 1447-1456. DOI: 10.1245/s10434-020-09335-3.
[9]	EI S, MIHALJEVIC AL, 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.
[10]	KUROKI T, EGUCHI S. Laparoscopic parenchyma-sparing pancreatectomy[J]. J Hepatobiliary Pancreat Sci, 2014, 21(5): 323-327. DOI: 10.1002/jhbp.29.
[11]	RHEE H, PARK MS. The role of imaging in current treatment strategies for pancreatic adenocarcinoma[J]. Korean J Radiol, 2021, 22(1): 23-40. DOI: 10.3348/kjr.2019.0862.
[12]	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.
[13]	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.
[14]	AUSSILHOU B, FTÉRICHE FS, BOUQUOT M, et al. Laparoscopic pancreatic enucleation: cystic lesions and proximity to the Wirsung duct increase postoperative pancreatic fistula[J]. Surg Endosc, 2022. DOI: 10.1007/s00464-022-09527-w.[Online ahead of print]
[15]	STROBEL O, CHERREZ A, HINZ U, et al. Risk of pancreatic fistula after enucleation of pancreatic tumours[J]. Br J Surg, 2015, 102(10): 1258-1266. DOI: 10.1002/bjs.9843.
[16]	BEGER HG, POCH B, VASILESCU C. Benign cystic neoplasm and endocrine tumours of the pancreas—when and how to operate—an overview[J]. Int J Surg, 2014, 12(6): 606-614. DOI: 10.1016/j.ijsu.2014.03.020.
[17]	BEGER HG, MAYER B, POCH B. Duodenum-preserving pancreatic head resection: A local parenchyma-sparing treatment of benign and premalignant tumors of the pancreatic head[J]. Chirurg, 2019, 90(9): 736-743. DOI: 10.1007/s00104-019-0942-0.
[18]	BEGER HG, 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.
[19]	SLEZAK LA, ANDERSEN DK. Pancreatic resection: effects on glucose metabolism[J]. World J Surg, 2001, 25(4): 452-460. DOI: 10.1007/s002680020337.
[20]	BEGER HG, SCHWARZ M, POCH B. Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions[J]. J Gastrointest Surg, 2012, 16(11): 2160-2166. DOI: 10.1007/s11605-012-1929-z.
[21]	BEGER HG, MAYER B, YANG Y, et al. Duodenum-preserving pancreatic head resection for benign tumors, cystic neoplasms and neuroendocrine adenomas-an overview[J]. Chin J Surg, 2021, 59(7): 608-617. DOI: 10.3760/cma.j.cn112139-20210519-00218. BEGER HG, MAYER B, YANG Y, 等. 保留十二指肠的胰头切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的系统分析[J]. 中华外科杂志, 2021, 59(7): 608-617. DOI: 10.3760/cma.j.cn112139-20210519-00218.
[22]	GURUSAMY KS, LUSUKU C, HALKIAS C, et al. Duodenum-preserving pancreatic resection versus pancreaticoduodenectomy for chronic pancreatitis[J]. Cochrane Database Syst Rev, 2016, 2: CD011521. DOI: 10.1002/14651858.CD011521.pub2.
[23]	DIENER MK, HÜTTNER FJ, KIESER M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial[J]. Lancet, 2017, 390(10099): 1027-1037. DOI: 10.1016/S0140-6736(17)31960-8.
[24]	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.
[25]	HONG D, CHENG J, WU W, et al. How to perform total laparoscopic duodenum-preserving pancreatic head resection safely and efficiently with innovative techniques[J]. Ann Surg Oncol, 2021, 28(6): 3209-3216. DOI: 10.1245/s10434-020-09233-8.
[26]	KIMURA W, NAGAI H. Study of surgical anatomy for duodenum-preserving resection of the head of the pancreas[J]. Ann Surg, 1995, 221(4): 359-363. DOI: 10.1097/00000658-199504000-00005.
[27]	KRISTINSSON SY, GRIDLEY G, HOOVER RN, et al. Long-term risks after splenectomy among 8, 149 cancer-free American veterans: a cohort study with up to 27 years follow-up[J]. Haematologica, 2014, 99(2): 392-398. DOI: 10.3324/haematol.2013.092460.
[28]	EDGREN G, ALMQVIST R, HARTMAN M, et al. Splenectomy and the risk of sepsis: a population-based cohort study[J]. Ann Surg, 2014, 260(6): 1081-1087. DOI: 10.1097/SLA.0000000000000439.
[29]	KORREL M, LOF S, SARIREH BA, et al. Short-term outcomes after spleen-preserving minimally invasive distal pancreatectomy with or without preservation of splenic vessels: a pan-european retrospective study in high-volume centers[J]. Ann Surg, 2021. DOI: 10.1097/SLA.0000000000004963.
[30]	GAO B, SU S, YANG X, et al. A commentary on "Splenic vessels preserving versus Warshaw technique in spleen preserving distal pancreatectomy: A systematic review and meta-analysis"(Int J Surg 2022;103: 106686)[J]. Int J Surg, 2022 : 106967. DOI: 10.1016/j.ijsu.2022.106967.
[31]	YONGFEI H, JAVED AA, BURKHART R, et al. Geographical variation and trends in outcomes of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel preservation: A meta-analysis[J]. Int J Surg, 2017, 45: 47-55. DOI: 10.1016/j.ijsu.2017.07.078.
[32]	DAI MH, SHI N, XING C, et al. Splenic preservation in laparoscopic distal pancreatectomy[J]. Br J Surg, 2017, 104(4): 452-462. DOI: 10.1002/bjs.10434.
[33]	DOKMAK S. Medial or lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy?[J]. Surgery, 2012, 152(1): 143-144. DOI: 10.1016/j.surg.2012.03.029.