腹腔镜下根治性顺行模块化胰脾切除术的现状与展望

Current Status and Future Prospects of Laparoscopic Radical Antegrade Modular Pancreatosplenectomy

摘要: 胰腺癌是公认的最具侵袭性和致命性的恶性肿瘤之一，其中约20%的病例为胰体尾部癌症。由于该类型癌症生长迅速且早期缺乏明显症状，许多患者在诊断时已经错过了最佳治疗时机。手术是唯一可能治愈的手段，但传统的远端胰腺切除术和脾切除术存在较高的阳性切缘率、较低的淋巴结清扫率和较差的总体生存率，已发表的证据表明经过传统手术治疗的病人，其五年生存率介于8%至22%之间。2003年，Strasberg等人提出了一种新的手术方法——根治性顺行模块化胰脾切除术(Radical Antegrade Modular Pancreatosplenectomy, RAMPS)，旨在提供更好的肿瘤切除效果、提高R0切除率并改善患者的长期预后。RAMPS的五年总体生存率可高达30%~40%。随着腹腔镜技术的不断进步，腹腔镜下根治性顺行模块化胰脾切除术(Laparoscopic Radical Antegrade Modular Pancreatosplenectomy, L-RAMPS)作为一种微创手术，具有术后恢复快等优势，逐渐获得越来越多外科医师的关注。文章总结了这种手术的现状，并展望其未来发展。

Abstract: Pancreatic cancer is widely recognized as one of the most aggressive and lethal malignant tumors, with approximately 20% of cases occurring in the body and tail of the pancreas. Due to the rapid growth of this cancer and the lack of obvious symptoms in its early stages, many patients miss the opportunity for optimal treatment by the time of diagnosis. Surgery remains the only potentially curative option; however, traditional distal pancreatectomy and splenectomy are associated with high positive margin rates, low lymph node dissection rates, and poor overall survival. Published evidence shows that the five-year survival rate for patients treated with traditional surgery ranges from 8% to 22%. In 2003, Strasberg et al. proposed a new surgical technique—Radical Antegrade Modular Pancreatosplenectomy (RAMPS)—designed to improve tumor resection, increase the R0 resection rate, and enhance long-term prognosis. The five-year overall survival rate for RAMPS can reach 30%~40%. With the continuous advancement of laparoscopic technology, Laparoscopic Radical Antegrade Modular Pancreatosplenectomy (L-RAMPS), as a minimally invasive procedure, offers advantages such as faster postoperative recovery and is gradually gaining more attention from surgeons. This article provides an overview of the current status of this surgery and discusses its potential future development.