Tóm tắt
Đặt vấn đề: Đánh giá kết quả bước đầu, chỉ định và biến chứng trong phẫu thuật nội soi hỗ trợ cắt khối tá tràng đầu tụy.
Phương pháp nghiên cứu: Mô tả tiến cứu 15 trường hợp được phẫu thuật tại Bệnh viện Bạch Mai từ 9/2016 – 9/2017.
Kết quả: Chỉ định mổ bao gồm: u bóng Vater (12 người bệnh), u đầu tụy (2 người bệnh), u nang đầu tụy (1 người bệnh). Tuổi trung bình: 53,6 ± 11,8 (dao động 37 – 72 tuổi), thời gian mổ trung bình 265,3 ± 55 phút trong đó thời gian mổ nội soi 139,5 ± 44,3 phút với đường mổ mở dài 8,6 ± 3,4 cm, tổng số hạch nạo vét trung bình 9 ± 2,6 hạch. Ba người bệnh chuyển mổ mở (20%) với lượng máu mất trong mổ trung bình 438 ± 305 ml, thời gian nằm viện 18,3 ngày. Tai biến và biến chứng gặp: 1 người bệnh cắt phải động mạch mạc treo tràng trên (6,7%), 6 người bệnh rò tụy (40%) chủ yếu mức độ A (26,6%), 4 người bệnh rò mật (26,7%), 3 người bệnh chậm lưu thông dạ dày (20%), 1 người bệnh tử vong (6,7%).
Kết luận: Phẫu thuật nội soi hỗ trợ có thể áp dụng điều trị các khối u vùng bóng Vater trên những người bệnh được lựa chọn. Hiệu quả và mức độ an toàn của phẫu thuật cần theo dõi thêm với số lượng lớn hơn.
Từ khóa: Cắt khối tá tụy, phẫu thuật nội soi hỗ trợ cắt khối tá tụy, cắt khối tá tụy với đường mở nhỏ.
Abstract
Introduction: We report the clinical short-term outcomes of laparoscopic-assisted pancreatoduodenectomy (LAPD) for periampullary tumors.
Material and Methods: A retrospective review of patients who underwent LAPD from 9/2016 to 9/2017 at Bach Mai University Hospital.
Results: Fifteen patients were included in this study. The preoperative diagnoses were ampullary carcinoma (n = 12), pancreatic head tumors (n = 2) and intraductal papillary mucinous neoplasm (n = 1). The median age was 53.6 years (range 37 – 72 years). The median operating time was 265.3 minutes (range 180 – 360 minutes) with the median time of laparoscopic approach was 139.5 mins and the median estimated blood loss was 438 ml (range 150 – 1241 ml). The median incision length for laparotomy was 8.6 cm (range 5 – 15 cm). The averaged lymph node collection was 9 ± 2.6 nodes. The median hospital stay was 18.3 days with three patients that underwent conventional open surgery. One patient with injury superior mesenteric artery (SMA) during laparoscopic approach that needed be to repaired. Postoperative complications were pancreatic fistula (40%), bile leakage (26.7%), delayed empty gastric (20%) and mortality (6.7%).
Conclusion: LAPD is a technically safe and feasible alternative treatment for selected patients with periampullary tumors. The long-term outcomes and potential benefits of this technique need to be obsevered in a larger patient population.
Keyword: Pancreatoduodenectomy, Laparoscopic-assisted pancreatoduodenectomy, Laparoscopic pancreatoduodenectomy assisted by mini-laparotomy.
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