机器人辅助胰十二指肠切除术在高龄患者的应用

doi:10.3877/cma.j.issn.1674-6899.2021.01.003

目的

探讨达芬奇机器人辅助胰十二指肠切除术(robotic pancreaticoduodenectomy，RPD)在高龄患者的安全性及临床效果。

方法

回顾性分析2016年12月至2020年5月于中山大学附属第一医院胆胰外科接受RPD、年龄≥70岁患者的临床资料，分析术后转归。

结果

共16例年龄≥70岁的患者接受RPD，其中男9例、女7例；年龄70～85岁，平均(73.6±4.2)岁。所有患者均顺利完成RPD，无中转开腹。病因包括6例壶腹癌、6例胰腺导管腺癌、1例胰腺神经内分泌肿瘤、1例胰管内乳头状黏液性肿瘤、1例十二指肠乳头癌、1例十二指肠乳头腺瘤伴高级别上皮内瘤变。中位手术时间413 min(IQR：366～522 min)，中位术中出血量50 ml(IQR：50～62.5 ml)，16例患者均获得R0切除。3例(18.8%)患者术后发生并发症，包括1例(6.2%)术后早期胰肠吻合口出血，通过再手术止血；3例(18.8%)B级胰瘘合并腹腔内感染；1例(6.2%)胃排空延迟。无围手术期死亡。中位术后住院时间13 d(IQR：12～18 d)。

结论

RPD对于高龄患者安全可靠，近期治疗效果满意。

关键词: 机器人, 胰十二指肠切除术, 高龄患者

Objective

To evaluate the safety and efficacy of robotic-assisted pancreaticoduodenectomy in the elderly patients.

Methods

The clinicopathological data of 16 patients who were over 70 years old and underwent robotic-assisted pancreaticoduodenectomy between Dec.2016 and May 2020 at Department of Pancreatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University, were analyzed retrospectively.

Results

There were 9 males and 7 females, with the mean age of (73.6±4.2)years (from 70 to 85 years). Robotic-assisted pancreaticoduodenectomy was successfully completed in all 16 patients, with no conversion. In etiologies, there were 6 cases of ampullay carcinoma, 6 cases of pancreatic ductal adenocarcinoma, 1 case of pancreatic neuroendocrine tumor, 1 case of intraductal papillary mucinous neoplasm, 1 case of duodenal papillary carcinoma and 1 case of duodenal papillary adenoma with high-grade intraepithelial neoplasia. The median operative time was 413 min(IQR: 366-522 min)and the median intraoperative blood loss was 50 ml(IQR: 50-62.5 ml). Curative resection was achieved in all 16 patients. Postoperative complications occurred in 3 patients (18.8%), including pancreatojejunostomy bleeding in 1 patient (6.2%), which was successfully managed by reoperation; grade B postoperative pancreatic fistula with intra-abdominal infection in 3 patients (18.8%); and delay gastric emptying in 1 (6.2%). There was no perioperative mortality. The median postoperative hospitalization duration was 13 d (IQR: 12-18 d).

Conclusions

The robotic-assisted pancreaticoduodenectomy is safe and reliable procedure in the elderly patients, with good short-term outcome.

Key words: Robotic, Pancreaticoduodenectomy, The elderly patients

图1 达芬奇机器人系统辅助进行胰十二指肠切除术Trocar示意

图2 间接架桥式胰肠吻合术

表1 16例达芬奇机器人辅助胰十二指肠切除术患者的术后最终病理结果

病理分类	例数	肿瘤直径(cm)
壶腹癌	6	1.9(1.5～4.5)
胰腺导管腺癌	6	2.9(1.7～5.0)
胰腺神经内分泌肿瘤	1	2.2
胰管乳头状黏液性肿瘤	1	4.0
十二指肠乳头癌	1	1.5
十二指肠乳头高级别上皮内瘤变	1	1.0

表1 16例达芬奇机器人辅助胰十二指肠切除术患者的术后最终病理结果

病理分类	例数	肿瘤直径(cm)
壶腹癌	6	1.9(1.5～4.5)
胰腺导管腺癌	6	2.9(1.7～5.0)
胰腺神经内分泌肿瘤	1	2.2
胰管乳头状黏液性肿瘤	1	4.0
十二指肠乳头癌	1	1.5
十二指肠乳头高级别上皮内瘤变	1	1.0

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Application of robotic-assisted pancreaticoduodenectomy in the elderly patients

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Application of robotic-assisted pancreaticoduodenectomy in the elderly patients