Objective: To evaluate the safety and feasible of adjacent organ resection during laparoscopic pancreaticoduodenectomy(LPD), and summary the surgical strategies. Methods: Clinical data of 15 adjacent organ resections combined with LPD from March 2013 to September 2017 were reviewed.There were 10 male and 5 female patients aging from 20 to 86 years, and the body mass index ranged from 19.6 to 34.5 kg/m(2).Two patients had previous abdominal surgical history.Two patients underwent preoperative chemotherapy. Results: The resected adjacent organs included liver(n=4), stomach(n=3), colon(n=6), right kidney with embolectomy and vasoplastic of inferior vena cava(n=1), and spleen artery aneurysms(n=1). The operative time ranged from 280 to 450 minutes, and the blood loss ranged from 100 to 450 ml.The total complication rate was 5/15 and no one died in 90 days after surgery.The postoperative hospital stay ranged from 10 to 42 days with medium 18 days.The pathology included adenocarcinoma of stomach and duodenum(n=1), gastric cancer invading pancreas or duodenum(n=2), ampullary adenocarcinoma with left hepatolithiasis(n=1), ampullary adenocarcinoma with a benign lesion in left liver(n=1), ampullary adenocarcinoma with single liver metastasis(n=1), ampullary adenocarcinoma(n=1), pancreatic intraductal papillary mucinous neoplasm with splenic artery aneurysms(n=1), pancreatic neuroendocrine neoplasm with colon cancer(n=1), distal common bile duct adenocarcinoma involving righ hepatic duct(n=1), pancreatic neuroendocrine neoplasm invading inferior vena cava and right renal vein(n=1), duodenal adnocarcinoma(n=1), duodenal ewing's sarcoma(n=1), duodenal intesititialoma(n=2). The follow-up was from 3 to 40 months with the medium survival of 17.5 months. Conclusions: The oncological outcomes of PD combined with adjacent organ resection is acceptable.Surgical treatment for those patients with periampullary neoplasma and adjacent organ lesions should be aggressive.
目的： 评估腹腔镜胰十二指肠切除术(LPD)联合邻近器官切除的可行性和安全性。 方法： 收集2013年3月至2017年9月浙江省人民医院胃肠胰外科开展的15例LPD联合邻近器官切除术的临床资料，其中男性10例，女性5例，年龄20～86岁，体重指数19.6～34.5 kg/m(2)。术前有腹部手术史者2例，行新辅助化疗者2例。 结果： 15例患者中，腹腔镜胰十二指肠切除术联合肝脏部分切除4例，联合远端胃癌根治术3例，联合结肠切除术6例，联合右肾切除＋下腔静脉取栓及整形修补1例，联合脾动脉瘤双头结扎1例。手术时间280～450 min，出血量100～450 ml，并发症发生率33.3%，无术后90 d内死亡。术后住院时间10～42 d，中位时间18 d。术后病理学检查结果：胃、十二指肠双重癌1例，胃癌累及胰头和十二指肠2例，壶腹癌伴左肝内胆管结石1例，壶腹癌伴左肝良性肿瘤1例，壶腹癌伴肝寡转移1例，胆管癌侵及右肝管1例，壶腹癌伴梗阻性黄疸1例(首次误诊为胆管结石而手术)，胰腺神经内分泌癌伴结肠癌1例，十二指肠癌1例，十二指肠巨大间质瘤2例，十二指肠肉瘤1例，胰腺导管内乳头状黏液瘤伴脾动脉瘤1例，胰腺神经内分泌肿瘤侵及下腔静脉右肾静脉汇合处伴瘤栓形成1例。随访3～40个月，12例存活，3例死亡，中位生存时间17.5个月。 结论： 腹腔镜胰十二指肠切除术联合邻近器官切除的肿瘤治疗效果可。对拟行LPD，术前或术中发现合并肝脏、胃和结肠等邻近器官病变的患者，应根据病变的性质、部位选择手术治疗方式。.
Keywords: Extended resection; Laparoscopy; Pancreas; Pancreaticoduodenectomy.