Альманах клинической медицины. 2018; 46: 640-647
Лапароскопические операции на поджелудочной железе: 11-летний опыт специализированного центра
https://doi.org/10.18786/2072-0505-2018-466-640-647Аннотация
Актуальность. Хирургия поджелудочной железы (ПЖ) в силу анатомических и функциональных особенностей этого органа стала активно развиваться позже других разделов абдоминальной хирургии – в последние 25–30 лет прошлого века. Применение минимально инвазивных лапароскопических технологий в хирургии ПЖ пока недостаточно распространено.
Цель – оценить 11-летний опыт выполнения различных лапароскопических операций на ПЖ, накопленный одним хирургическим коллективом.
Материал и методы. С ноября 2007 по май 2018 г. у 371 пациента (153 мужчины и 218 женщин) были проведены лапароскопические операции на ПЖ по поводу рака органов билиопанкреатодуоденальной зоны (n = 260), доброкачественных опухолей ПЖ (n = 37), хронического панкреатита (n = 74). Выполнено 245 панкреатодуоденальных резекций, 52 дистальные резекции ПЖ (ЛДР), 35 операций Фрея (ОФ), 18 тотальных дуоденопанкреатэктомий, 8 продольных панкреатоеюностомий (ЛПЕС), 8 цистоэнтеростомий (ЛЦ), 3 энуклеации, 2 операции Бегера (ОБ).
Результаты. Лапароскопическая гастропанкреатодуоденальная резекция выполнена в 197 (80,4%) случаях, пилоросохраняющая панкреатодуоденальная резекция – в 48 (19,6%). Продолжительность операции составила 412 ± 101 минуту, объем кровопотери – 220 ± 152 мл, пребывание в стационаре – 19 ± 9 дней. ЛДР в 50 (96,2%) случаях была выполнена полностью лапароскопическим способом. Продолжительность операции составила 228 ± 74 минуты, объем кровопотери – 40 ± 50 мл, пребывание в стационаре – 8 ± 5 дней. При выполнении ОФ, ЛПЕС, ОБ и ЛЦ в 53 (93%) случаях вмешательства были выполнены полностью лапароскопическим способом в намеченном объеме. Продолжительность операций была следующей: ОФ – 436 ± 95, ЛПЕС – 406 ± 82, ОБ – 585 ± 134, ЛЦ – 327 ± 90 минут. Объем кровопотери составил для ОФ 227 ± 217, ЛПЕС – 150 ± 156, ОБ – 175 ± 106, ЛЦ – 60 ± 90 мл. Пребывание в стационаре после ОФ заняло 8 ± 4, ЛПЕС – 9 ± 7, ОБ – 4,5 ± 0,7, ЛЦ – 10 ± 9 дней.
Заключение. Лапароскопические операции в хирургии ПЖ сопровождаются минимальной кровопотерей, отсутствием осложнений со стороны ран, а также более быстрой активизацией и реабилитацией больных. Соблюдение необходимых условий внедрения лапароскопических технологий в специализированных клиниках должно улучшить результаты хирургического лечения.
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22. Sharpe SM, Talamonti MS, Wang CE, Prinz RA, Roggin KK, Bentrem DJ, Winchester DJ, Marsh RD, Stocker SJ, Baker MS. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg. 2015;221(1): 175–84. doi: 10.1016/j.jamcollsurg.2015.04.021.
23. Kurian MS, Gagner M. Laparoscopic side-toside pancreaticojejunostomy (Partington-Rochelle) for chronic pancreatitis. J Hepatobiliary Pancreat Surg. 1999;6(4): 382–6.
24. Cooper MA, Datta TS, Makary MA. Laparoscopic Frey procedure for chronic pancreatitis. Surg Laparosc Endosc Percutan Tech. 2014;24(1):e16–20. doi: 10.1097/SLE.0b013e31828f6edf.
25. Khaled YS, Ammori BJ. Laparoscopic lateral pancreaticojejunostomy and laparoscopic Berne modification of Beger procedure for the treatment of chronic pancreatitis: the first UK experience. Surg Laparosc Endosc Percutan Tech. 2014;24(5):e178–82. doi: 10.1097/SLE.0b013e31829ce803.
26. Tantia O, Jindal MK, Khanna S, Sen B. Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases. Surg Endosc. 2004;18(7): 1054–7. doi: 10.1007/s00464-003-9210-x.
Almanac of Clinical Medicine. 2018; 46: 640-647
Laparoscopic interventions in the pancreas: an 11-year experience of a specialized center
https://doi.org/10.18786/2072-0505-2018-466-640-647Abstract
Introduction: Due to anatomical and functional specifics of the pancreas, its surgery emerged somewhat later than that of other areas of abdominal surgery, i.e. in the last 25 to 30 years of the last century. Minimally invasive laparoscopic interventions on the pancreas are still used insufficiently.
Aim: To evaluate an 11-year experience of various laparoscopic interventions in the pancreas accumulated by one surgical team.
Materials and methods: From November 2007 to May 2018, 371 patients (153 male and 218 female) underwent various laparoscopic pancreatic procedures for cancers of the biliopancreatoduodenal zone (n = 260), benign pancreatic tumors (n = 37), and chronic pancreatitis (n = 74). We performed 245 laparoscopic pancreaticoduodenal resections, 52 laparoscopic distal resections (LDR), 35 laparoscopic Frey procedures (FP), 18 laparoscopic total duodenopancreatectomies, 8 laparoscopic longitudinal pancreaticojejunostomies (LLPJ), 8 laparoscopic cystoenterostomies (LCE), 3 enucleations, and 2 Beger procedures (BP).
Results: Laparoscopic gastropancreatoduodenal resection was performed in 197 (80.4%) cases and pylorus preserving pancreatoduodenal resection in 48 (19.6%) cases. The duration of the procedures was 412 ± 101 minutes, with blood loss volume of 220 ± 152 ml, and postoperative hospital stay of 19 ± 9 days. LDR was done laparoscopically in 50 (96.2%) patients; its duration was 228 ± 74 minutes, blood loss 40 ± 50 ml, and postoperative hospital stay 8 ± 5 days. FP, LLPJ, BP, and LCE were performed laparoscopically in 53 (93%) cases. FP lasted for 436 ± 95, LLPJ for 406 ± 82, BP for 585 ± 134, and LCE for 327 ± 90 minutes. The respective volumes of blood loos were 227 ± 217 mL in FP, 150 ± 156 mL in LLPJ, 175 ± 106 mL in BP, and 60 ± 90 mL in LCE. The postoperative hospital stay lasted for 8 ± 4 days after FP, 9 ± 7 days after LLPJ, 4.5 ± 0.7 days after BP, and 10 ± 9 days after LCE.
Conclusion: Laparoscopic surgery of the pancreas is associated with minimal blood loss, absence of wound infection, and more rapid patient activation and rehabilitation. Compliance with the necessary requirements to implementation of laparoscopic technologies in high-volume centers should improve surgical results.
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21. Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T,Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci. Forthcoming 2018. doi: 10.1002/jhbp.569.
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24. Cooper MA, Datta TS, Makary MA. Laparoscopic Frey procedure for chronic pancreatitis. Surg Laparosc Endosc Percutan Tech. 2014;24(1):e16–20. doi: 10.1097/SLE.0b013e31828f6edf.
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26. Tantia O, Jindal MK, Khanna S, Sen B. Laparoscopic lateral pancreaticojejunostomy: our experience of 17 cases. Surg Endosc. 2004;18(7): 1054–7. doi: 10.1007/s00464-003-9210-x.
