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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01): 27 -30. doi: 10.3877/cma.j.issn.1674-6899.2020.01.007

所属专题： 机器人手术； 文献资源库；

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两种不同机器人手术方式治疗胰头部实性假乳头状瘤的对比研究
赵之明 1, 姜楠 1, 尹注增 1, 许勇 1, 赵国栋 1, 高元兴 1, 刘荣 1 , †( )   
  1. 1. 100853 北京，解放军总医院第一医学中心肝胆外二科
  • 收稿日期:2020-01-02 出版日期:2020-02-28
  • 通信作者: 刘荣

A comparative study of two different types of robotic surgery for solid pseudopapillary tumor of the head of pancreas

Zhiming Zhao 1, Nan Jiang 1, Zhuzeng Yin 1, Yong Xu 1, Guodong Zhao 1, Yuanxing Gao 1, Rong Liu 1 , †( )   

  1. 1. The Second Department of Hepatobiliary Surgery, the First Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2020-01-02 Published:2020-02-28
  • Corresponding author: Rong Liu
  • About author:
    Corresponding author: Liu Rong, Email:
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目的

对比研究机器人肿瘤剜除术(robotic enucleation，REN)及机器人胰十二指肠切除术(robotic pancreaticoduodenectomy, RPD)在治疗胰头部胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas, SPT)的可行性及术后短期、长期结果。

方法

选取2016年1月至2019年4月解放军总医院第一医学中心肝胆外二科收治的28例胰头部SPT患者，其中10例患者进行REN，18例患者接受RPD。回顾性分析两组患者的一般资料、手术情况、术后随访等数据，对两组进行比较和评估。

结果

28例患者的中位年龄为29岁，男∶女比例为1∶8.33。REN组体质量指数值较低(P＝0.046)。两组患者均无围手术期死亡及二次手术。与RPD组相比，REN组的手术时间更短(P<0.001)、出血量更少(P＝0.009)。但两组的术后并发症率、胰瘘率、术后住院时间比较，差异均无统计学意义(P>0.05)。随访期内两组均无复发病例，REN组术后外分泌功能不全的发生率更低(P＝0.039)。

结论

机器人胰头部SPT肿瘤剜除术安全可行，保留器官及功能的优势明显，不会增加术后胰瘘及其他严重并发症。对于适合的胰头部SPT患者建议首选REN治疗。

关键词: 胰腺, 实性假乳头状瘤, 机器人
Objective

To compare the feasibility of robotic enucleation (REN) and robotic pancreatoduodenectomy (RPD) in the treatment of solid pseudopapillary tumor of the pancreas (SPT) in the head of the pancreas and the short-term and long-term results.

Methods

From Jan. 2016 to Apr. 2019, 28 patients with SPT at the head of pancreas, 10 patients resected REN and 18 patients resected RPD were selected. Retrospectively analysis of the two groups of patients with general information, surgery, postoperative follow-up and other data, the two groups were compared and evaluated.

Results

The median age was 29 years old, and the ratio of male to female was 1∶8.33. The BMI of REN group was less (P=0.046). There was no perioperative death or secondary operation in both groups. Compared with RPD group, REN group had shorter operation time (P<0.001) and less bleeding (P=0.009). However, there was no significant difference in postoperative complication rate, pancreatic fistula rate and postoperative hospital stay between the two groups (P>0.05). During the follow-up period, there was no recurrence in both groups, and the incidence of postoperative exocrine dysfunction was lower in REN group (P=0.039).

Conclusions

Robotic enucleation of tumor is safe and feasible, with obvious advantages of organ and function preservation, and will not increase postoperative pancreatic fistula and other serious complications. It is suggested that robotic enucleation should be the first choice for patients with SPT in the head of pancreas.

Key words: Pancreas, Solid pseudopapillary tumor, Robotic
表1 胰头部胰腺实性假乳头状瘤患者的两组一般情况比较
组别 例数 年龄[岁，median (IQR)] 性别(例，男性∶女性) 体质量指数( kg/m2， ±s) ASA评分(分， ±s)
RPD组 18 32.5(18.3～42.5) 2∶16 23.7±4.2 1.9±0.3
REN组 10 26.5(18.5～35.5) 1∶9 20.7±2.3 1.9±0.3
P值 ? 0.494 1.000 0.046 0.931
表2 胰头部胰腺实性假乳头状瘤患者的两组术中及术后情况对比
项目 RPD组(18例) REN组(10例) P值
手术时间[min, median (IQR)] 232.5(197.8～271.5) 109(85.0～177.5) <0.001
术中出血量[ml, median (IQR)] 100(50～100) 50(20～50) 0.009
术后住院时间[d，median (IQR)] 9(7.0～12.8) 6.0(4.5～12.0) 0.089
严重并发症(例，Clavien ≥3级) 3 0 0.533
术后胰瘘分级(例) ? ? ?
? A∶B∶C 10∶1∶0 2∶3∶0 0.063
? 临床相关胰瘘(B和C) 1 3 0.116
术后出血(例) 2 0 0.524
胃排空障碍(例) 2 0 0.524
术后胆漏(例) 1 0 1.000
二次入院(例) 1 0 1.000
肿瘤大小[cm, median (IQR)] 4.8(2.9～6.0) 6(4.0～13.0) 0.245
表3 胰头部胰腺实性假乳头状瘤患者的两组术后远期结果对比[例(%)]
组别 例数 术后内分泌功能不全 术后外分泌功能不全
RPD组 18 1(5.6) 7(38.9)
REN组 10 0(0.0) 0(0.0)
P值 ? 1.000 0.030
1
Mao C, Guvendi M, Domenico DR, et al. Papillary cystic and solid tumors of the pancreas: a pancreatic embryonic tumor. Studies of three cases and cumulative review of the world′s literature [J]. Surgery, 1995，118(5): 821-828.
2
Machado MC, Machado MA, Bacchella T, et al. Solid pseudopapillary neoplasm of the pancreas：distinct patterns of onset, diagnosis, and prognosis for male versus female patients [J]. Surgery, 2008，143(1): 29-34.
3
Liu R, Liu Q, Zhao ZM, et al. Robotic versus laparoscopic distal pancreatectomy: a propensity score-matched study [J]. J Surg Oncol, 2017，116(4): 461-469.
4
Hackert T, Hinz U, Fritz S, et al. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections[J]. Langenbecks Arch Surg, 2011，396(8): 1197-1203.
5
Cauley CE, Pitt HA, Ziegler KM, et al. Pancreatic enucleation: improved outcomes compared to resection [J]. J Gastrointest Surg, 2012，16(7): 1347-1353.
6
Liu R, Zhang T, Zhao ZM, et al. The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center [J]. Surg Endosc, 2017，31(6): 2380-2386.
7
刘荣，赵国栋. LR式机器人胰十二指肠切除术手术方法建立和技术优化[J/CD]. 中华腔镜外科杂志(电子版), 2016, 9(4):193-195.
8
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After [J]. Surgery, 2017，161(3): 584-591.
9
Baek JH, Lee JM, Kim SH, et al. Small (<or＝3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT [J]. Radiology, 2010，257(1): 97-106.
10
Kawamoto S, Scudiere J, Hruban RH, et al. Solid-pseudopapillary neoplasm of the pancreas: spectrum of findings on multidetector CT [J]. Clin Imaging, 2011，35(1): 21-28.
11
Zhang T, Xu J, Wang T, et al. Enucleation of pancreatic lesions: indications, outcomes, and risk factors for clinical pancreatic fistula [J]. J Gastrointest Surg, 2013，17(12): 2099-2104.
12
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.
13
Liu R, Wang ZZ, Gao YX, et al. Application of End-to-end Anastomosis in Robotic Central Pancreatectomy [J]. J Vis Exp, 2018, (136), e57495, doi： 10.3791/57495 (2018)．
14
Stewart CL, Meguid C, Chapman B, et al. Evolving trends towards minimally invasive surgery for solid-pseudopapillary neoplasms [J]. Ann Surg Oncol, 2016，23(13): 4165-4168.
15
Guerra F, Giuliani G, Bencini L, et al. Minimally invasive versus open pancreatic enucleation. systematic review and meta-analysis of surgical outcomes [J]. J Surg Oncol, 2018，117(7): 1509-1516.
16
Tran TC, Lanschot JJ, Bruno MJ, et al. Functional changes after pancreatoduodenectomy: diagnosis and treatment [J]. Pancreatology, 2009，9(6): 729-737.
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