腹腔镜根治性顺行模块化胰脾切除术1例报告及文献复习
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摘要
目的:总结腹腔镜根治性顺行模块化胰脾切除术(Lap-RAMPS)的安全性、有效性。方法:回顾分析为1例患者行Lap-RAMPS的临床资料,并复习相关文献。结果:患者成功完成腹腔镜手术,手术时间230 min,术中出血量50 mL,术后住院7 d,无并发症发生。术后病理诊断:胰腺导管腺癌,浸润胰腺腺泡并突破胰腺外膜,累及周围脂肪、神经;肾上腺见癌细胞转移;脾脏未见肿瘤;淋巴结未见癌细胞转移。结论:Lap-RAMPS手术难度大、技术要求高,术者应具备丰富的开放手术经验,手术是安全、可行的。
Objective:To summarize the safety and efficacy of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS).Methods:The clinical data of one patient who underwent Lap-RAMPS were retrospectively analyzed,and relevant literatures were reviewed.Results:The laparoscopic surgery was performed successfully,the operation time was 230 min,the intraoperative blood loss was 50 mL,the hospitalization time was 7 d without complications.Postoperative pathological diagnosis was pancreatic ductal adenocarcinoma,infiltrating the pancreatic acinar and breaking through the pancreatic outer membrane,involving peripheral fat and nerves.Adrenal metastasis was found.No tumor was found in the spleen;no metastasis was found in the lymph nodes.Conclusions:Lap-RAMPS is safe,feasible,difficult and technically demanding,and extensive experience of laparotomy is needed.
Objective:To summarize the safety and efficacy of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS).Methods:The clinical data of one patient who underwent Lap-RAMPS were retrospectively analyzed,and relevant literatures were reviewed.Results:The laparoscopic surgery was performed successfully,the operation time was 230 min,the intraoperative blood loss was 50 mL,the hospitalization time was 7 d without complications.Postoperative pathological diagnosis was pancreatic ductal adenocarcinoma,infiltrating the pancreatic acinar and breaking through the pancreatic outer membrane,involving peripheral fat and nerves.Adrenal metastasis was found.No tumor was found in the spleen;no metastasis was found in the lymph nodes.Conclusions:Lap-RAMPS is safe,feasible,difficult and technically demanding,and extensive experience of laparotomy is needed.
引文
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[7] 徐晓武,吉顺荣,许文彦,等.腹腔镜根治性顺行性模块化胰脾切除术在胰体尾癌治疗中的应用现状及展望[J].腹腔镜外科杂志,2018,23(9):661-663.
[8] Chun YS.Role of Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Pancreatic Cancer[J].Ann Surg Oncol,2018,25(1):46-50.
[9] Strasberg SM,Fields R.Left-sided pancreatic cancer:distal pancreatectomy and its variants:radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection[J].Cancer J,2012,18(6):562-570.
[10] Strasberg SM,Linehan DC,Hawkins WG.Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas:ability to obtain negative tangential margins[J].J Am Coll Surg,2007,204(2):244-249.
[11] Lee SH,Kang CM,Hwang HK,et al.Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria:long-term (>median 3 years) oncologic outcomes[J].Surg Endosc,2014,28(10):2848-2855.
[12] Kim EY,Hong TH.Initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer in a single institution:technical aspects and oncological outcomes[J].BMC Surg,2017,17(1):2.
[13] Zhang AB,Wang Y,Hu C,et al.Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma:a single-center experience[J].J Zhejiang Univ Sci B,2017,18(6):532-538.
[14] Ome Y,Hashida K,Yokota M,et al.Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach[J].Surg Endosc,2017,31(11):4836-4837.
[15] 刘辰,金凯舟,虞先濬.腹腔镜根治性顺行模块化胰脾切除术的若干关键问题讨论[J].腹腔镜外科杂志,2018,23(9):647-649.
[16] 成伟,滕雄,曾诗语,等.腹腔镜下根治性顺行模块化胰脾切除术在胰体尾恶性肿瘤切除中的应用(附6例报告)[J].腹腔镜外科杂志,2018,23(9):689-693.
[2] Hidalgo M.Pancreatic cancer[J].N Engl J Med,2010,362(17):1605-1617.
[3] Strasberg SM,Drebin JA,Linehan D.Radical antegrade modular pancreatosplenectomy[J].Surgery,2003,133(5):521-527.
[4] Andrén-Sandberg A,Wagner M,Tihanyi T,et al.Technical aspects of left-sided pancreatic resection for cancer[J].Dig Surg,1999,16(4):305-312.
[5] Zeng H,Chen W,Zheng R,et al.Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J].Lancet Glob Health,2018,6(5):e555-e567.
[6] 虞先濬,刘亮,徐华祥,等.胰腺癌综合诊治指南(2018版)[S].临床肝胆病杂志,2018,34(10):2109-2120.
[7] 徐晓武,吉顺荣,许文彦,等.腹腔镜根治性顺行性模块化胰脾切除术在胰体尾癌治疗中的应用现状及展望[J].腹腔镜外科杂志,2018,23(9):661-663.
[8] Chun YS.Role of Radical Antegrade Modular Pancreatosplenectomy (RAMPS) and Pancreatic Cancer[J].Ann Surg Oncol,2018,25(1):46-50.
[9] Strasberg SM,Fields R.Left-sided pancreatic cancer:distal pancreatectomy and its variants:radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection[J].Cancer J,2012,18(6):562-570.
[10] Strasberg SM,Linehan DC,Hawkins WG.Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas:ability to obtain negative tangential margins[J].J Am Coll Surg,2007,204(2):244-249.
[11] Lee SH,Kang CM,Hwang HK,et al.Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria:long-term (>median 3 years) oncologic outcomes[J].Surg Endosc,2014,28(10):2848-2855.
[12] Kim EY,Hong TH.Initial experience with laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer in a single institution:technical aspects and oncological outcomes[J].BMC Surg,2017,17(1):2.
[13] Zhang AB,Wang Y,Hu C,et al.Laparoscopic versus open distal pancreatectomy for pancreatic ductal adenocarcinoma:a single-center experience[J].J Zhejiang Univ Sci B,2017,18(6):532-538.
[14] Ome Y,Hashida K,Yokota M,et al.Laparoscopic radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz approach[J].Surg Endosc,2017,31(11):4836-4837.
[15] 刘辰,金凯舟,虞先濬.腹腔镜根治性顺行模块化胰脾切除术的若干关键问题讨论[J].腹腔镜外科杂志,2018,23(9):647-649.
[16] 成伟,滕雄,曾诗语,等.腹腔镜下根治性顺行模块化胰脾切除术在胰体尾恶性肿瘤切除中的应用(附6例报告)[J].腹腔镜外科杂志,2018,23(9):689-693.