目的

探讨机器人胰腺中段切除术的手术安全性及远端胰腺消化道不同重建方式疗效对比。

方法

回顾分析2018 年6 月至2022 年8 月接受机器人胰腺中段切除术的10 例患者临床资料，评价近期临床疗效及远期预后。 分析手术时间、术中出血量、术后住院时间、术后胰瘘、腹腔出血、腹腔感染发生率、术后远期胰腺内外分泌功能异常情况。

结果

10 例患者中男性3 例，女性7 例，平均年龄47.2±11.5 岁，平均体质量指数（body mass index，BMI）22.5±2.9 kg/m²，远端胰腺消化道重建方式包括胰管空肠吻合4 例，胰胃吻合3 例，胰腺端端吻合3 例。 平均手术时间273.0±54.4 min，平均术中出血量120.0±45.8 ml。 术后4 例出现生化漏，3 例出现B 级胰瘘。 其中1 例合并消化道出血、腹腔感染（肺炎克雷伯菌）行穿刺引流，另2 例行内镜下胰管支架置入术。 术后病理提示2 例为浆液性囊腺瘤，2 例为黏液性囊腺瘤，2 例为胰腺神经内分泌肿瘤，3 例为胰腺导管内乳头状黏液瘤，1 例为肾透明细胞癌术后胰腺转移。 术后平均住院14.0±7.7 d。 平均随访33.8±14.3 个月。 10 例患者均有不同程度的远端胰腺萎缩，所有患者均未发生胰腺内外分泌功能不足。

结论

机器人胰腺中段切除术安全可行，尽管术后早期存在相对较高的胰瘘发生率，远期的胰腺内外分泌功能未受到明显影响。 胰胃吻合及胰腺端端吻合术后发生远端胰腺萎缩与胰肠吻合有可比性，短期临床疗效与随访长期获益相当，结论需要高质量研究进一步验证。

Objective

To explore the surgical safety of robotic central pancreatectomy and compare the efficacy of different methods of reconstruction for the distal pancreatic stump.

Methods

Clinical data of 10 patients who underwent robotic central pancreatectomy from Jun. 2018 to Aug. 2022 were retrospectively analyzed to evaluate short-term clinical outcomes and long-term prognosis.The operative time， intraoperative blood loss， postoperative hospital stay， postoperative pancreatic fistula， peritoneal hemorrhage， incidence of peritoneal infection， and long-term abnormal pancreatic secretory function were analyzed.

Results

Among the 10 patients， there were 3 males and 7 females， with an average age of 47.2±11.5 years and an average body mass index（BMI）of 22.5±2.9 kg/m². The methods of reconstruction of the distal pancreatic stump included pancreaticojejunostomy in 4 cases， pancreatogastric anastomosis in 3 cases， and end-to-end pancreatic anastomosis in 3 cases. The average operation time was 273.0±54.4 minutes， and the average intraoperative blood loss was 120.0±45.8 ml. After the surgery， biochemical leakage occurred in 4 patients，and 3 patients developed Grade B pancreatic fistula. Among them， 1 case combined with gastrointestinal bleeding and abdominal infection （Klebsiella pneumonia） who underwent puncture drainage， while the other 2 cases underwent endoscopic pancreatic duct stent placement. Pathological examination revealed 2 cases of serous cystadenoma， 2 cases of mucinous cystadenoma， 2 cases of pancreatic neuroendocrine tumors， 3 cases of intraductal papillary mucinous neoplasms （IPMN）， and 1 case of renal cell carcinoma metastases. The average length of hospital stay was 14.0±7.7 days. The average follow-up period was 33. 8±14. 3 months. All the 10 patients had distal pancreatic atrophy. None of the patients developed endocrine or exocrine insufficiency.

Conclusion

Robotic central pancreatectomy is safe and feasible. Although there is a relatively high incidence of pancreatic fistula in the early postoperative period，long-term pancreatic exocrine and endocrine functions are not significantly affected，high-quality studies are warranted to verify the conclusion.