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Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience.

机译：腹腔镜手助胰十二指肠切除术：英国的初步经验。

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BACKGROUND: By and large, the limited world experience with laparoscopic pancreaticoduodenectomy (PD) has been unfavorable, but the laparoscopic hand-assisted approach to PD has recently shown promising results. We report the first successful UK experience with laparoscopic hand-assisted PD (LHAPD). METHODS: A 62-year-old man who presented with painless obstructive jaundice was found at endoscopy, to have an ampullary tumor. Preoperative biopsy specimens confirmed the diagnosis of an adenocarcinoma, and CT showed no evidence of either vascular involvement or metastatic disease. A staging laparoscopy showed no intraabdominal metastases, and an LHAPD was performed using a Gelport. RESULTS: The intraoperative course was uneventful. Two units of blood were transfused intraoperatively, but no postoperative blood transfusion was required. The operative time was 11 h (plus a 30-min break). The patients postoperative recovery was uneventful except for superficial pressure sores over the buttocks and elbows. The patient resumed oral fluid and dietary intake on the 1st and 3rd postoperative days, respectively, and was discharged from hospital on the 9th postoperative day. Histology demonstrated an ampullary adenocarcinoma with clear resection margins and involvement of two of the 13 lymph nodes examined. At 2-month follow-up, the patient remains well and is receiving adjuvant chemotherapy. CONCLUSIONS: LHAPD achieves good oncological clearance and can be performed safely in selected patients. The early promising results with this approach will undoubtedly encourage wider adoption of this procedure and are likely to widen the selection criteria.
机译：背景：总体而言，腹腔镜胰十二指肠切除术（PD）的世界经验有限，这是不利的，但最近腹腔镜手动辅助PD疗法已显示出令人鼓舞的结果。我们报告了英国首例成功的腹腔镜手动辅助PD（LHAPD）经验。方法：内镜检查发现一名患有无痛性阻塞性黄疸的62岁男子患有壶腹肿瘤。术前活检标本证实了腺癌的诊断，CT显示无血管受累或转移性疾病的证据。分期腹腔镜检查未见腹腔内转移，使用Gelport进行LHAPD。结果：术中病程进展顺利。术中输注了两个单位的血液，但术后无需输血。手术时间为11小时（加上30分钟的休息时间）。除了臀部和肘部的表面压疮外，患者的术后恢复均无异常。该患者分别在术后第1天和第3天恢复口服液和饮食摄入，并在术后第9天出院。组织学证实壶腹腺癌切除边缘清晰，受累的13个淋巴结中有2个受累。在2个月的随访中，患者情况良好，正在接受辅助化疗。结论：LHAPD具有良好的肿瘤清除率，可以在部分患者中安全地进行。这种方法的早期有希望的结果无疑将鼓励该方法的更广泛采用，并有可能扩大选择标准。

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