| Laparoscopicpancreaticoduodenectomy,LPD is the application of laparoscopic techniques of complete or auxiliary of pancreaticoduodenal resection surgery.It is one of the most complicated laparoscopic operations[1].The first case of LPD in the world was reported in 1994,and it was first carried out by Chinese scholars in 2002[2].in the last 10 years,with the development of laparoscopic pancreatic surgery technology and the accumulation of experience,as well as the widespread application of high-definition laparoscopy and the continuous improvement of laparoscopic operating instruments,laparoscopic pancreatic surgery has achieved a breakthrough development.The results showed that the laparoscopic pancreatectomy still had significant minimally invasive advantages compared with traditional open surgery[3]Our team began to carry out LPD on March 8,2017.Until the end of December,2018,241 cases of complete laparoscopic pancreatoduodenectomy have been successfully implemented.In this paper,clinical data of 80 cases in our team were retrospectively analyzed.All the 80 cases of LPD surgeries were performed by the same surgical team with the same laparoscopic assistant.In the 80 cases of LPD surgery,the assistant was fully involved in the selection of perioperative patients,preoperative preparation,intraoperative cooperation with the operator,operation of the main steps during the operation,postoperative patient monitoring,perioperative complications management and treatments.The clinical experience and experience of individuals involved in LPD surgery were summarized,and combined with the clinical experience of the team,in order to provide certain reference for reducing the incidence of complications in the perioperative period of LPD and improving the surgical safety.Research purposeThis paper summarized the laparoscopic assistant's experience of LPD,combined with the clinical experience and summary of the surgical team.In order to provide certain reference for improving the tacit understanding and fluency of the cooperation between the operator and the assistant,reducing the incidence of complications in LPD surgery and improving the safety of surgery.The research methodsRetrospectively analyzed and summarized the team experience in 80 cases of laparoscopic resection of pancreas duodenum since the beginning of May 2017 to the end of October,2018.Summarizes individuals and performer in surgical patients with preoperative preparation,intraoperative cooperation,intraoperative intermittent perforation pancreatojejunostomy method,parachute bile intestinal anastomosis method,single Prolene thread continuous stomach jejunum anastomosis and some of the main steps of experience.The results of the studyAmong the 80 cases of laparoscopic pancreaticoduodenectomy,68 cases were completely laparoscopic pancreaticoduodenectomy,and 12 cases were transferred to laparotomy.The operative time of the first 40 patients was 230min to 390min,with an average(275.6 ± 31.5)min;the operative time of the second 40 patients was 160min to 340min,with an average(236.4±26.5)min.The intraoperative blood loss was 50-800ml,with an average(275±35)ml.Postoperative hospitalization time was 7-54d,with an average hospitalization time(17.4±4.5)d.Postoperative pathology:Perioperative mortality was 4(5.00%).Postoperative hemorrhage in 6 cases(18.75%),gastrointestinal bleeding in 1 case(16.67%),intra-abdominal vascular hemorrhage in 5 cases(83.33%),bleeding direct cause of death in 2 cases(33.33%),lung infection and multiple organ function failure after abdominal cavity bleeding and eventually death in 1 case(16.67%).The pancreaticojejunostomy anastomosis time was 14-35min(mean 18.22.5).Postoperative pancreatic fistula occurred in 15 cases(18.75%),including grade A pancreatic fistula in 12 cases(80%),grade B pancreatic fistula in 2 cases(13.33%),and grade C pancreatic fistula in 1 case(6.67%).The mean time of choledochojejunostomy was 9-23min(14.2 ± 2.7).Bile fistula in 12 cases(15%).The mean time of gastrojejunostomy was 10-17min(12.4 ±1.5min).Postope rative gastroparesis was found in 21 patients(26.25%).After continuous diet prohibition and gastrointestinal decompression,infection control and nutritional support,maintenance of water,electrolyte and acid-base balance,appropriate gastric dynamic drug treatment and conservative treatment such as acupuncture and moxibustion,the recovery time of the patients was 13-48 days,with an average(18.6±3.5)days.No patients with gastroparesis underwent reoperation.ConclusionLPD is safe and feasible for the team with rich experience in open pancreaticoduodenectomy and certain laparoscopic surgery.The degree of tacit cooperation between the endoscopic assistant and the surgeon can significantly shorten the operation time and increase the smoothness of the operation.The tacit teamwork of laparoscopic pancreaticoduodenectomy is extremely important.Therefore,when laparoscopic pancreaticoduodenectomy is carried out,fixed personnel should be employed as far as possible,which can not only significantly shorten the operation time,but also reduce the incidence of surgical complications to a certain extent.Intermittent perforation pancreatojejunostomy,parachute choledochojejun ostomy,and single Prolene thread continuous gastrointestinal anastomosis are inde d feasible. |
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