[Choices of methods in dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy].

Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions: Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.目的： 探讨腹腔镜胰十二指肠切除术中胰腺颈部离断的方法、处理技巧和经验。 方法： 回顾性分析2014年12月至2017年1月福建医科大学附属协和医院基本外科对58例壶腹周围肿瘤患者行腹腔镜胰十二指肠切除术的病例资料。男性26例，女性32例，年龄18～65岁，平均年龄(46±12)岁。 结果： 58例患者均手术顺利，3例因早期学习曲线于腹腔镜下完整切除标本后取辅助切口行开放吻合，2例因肿瘤侵犯门静脉或肠系膜上静脉中转开放手术，余53例完全腹腔镜或腹腔镜联合机器人完成手术。42例先结扎胃十二指肠动脉，贯通胰后隧道悬吊胰腺后再由下往上离断胰腺颈部；13例充分分离胰后间隙，由下往上离断胰腺颈部，结扎胃十二指肠动脉；3例先结扎胃十二指肠动脉，游离胰腺颈部上缘的门静脉和胰腺颈部下缘的肠系膜上静脉，由前往后逐步离断胰腺颈部。平均断胰时间(34.9±9.7)min，平均断胰出血量(30.1±8.2)ml。术后并发症主要包括，胰瘘7例(生化漏2例，B级3例，C级2例)，胆瘘3例，胃瘘1例，胃排空延迟(C级)1例，腹腔感染5例，肝功能衰竭1例，腹腔出血2例，再次手术2例，1例围手术期死亡，其余患者均康复出院。术后平均住院时间(14.2±5.1)d。 结论： 胰腺颈部的离断是腹腔镜胰十二指肠切除术的重要步骤，应充分重视，同时应根据术中探查情况结合术前影像学检查选择合适的离断胰腺颈部的方法。.