胰十二指肠切除术在胰腺恶性肿瘤治疗方面的当前进展及未来展望

Current Progress and Future Prospects of Pancreaticoduodenectomy in the Treatment of Pancreatic Malignant Tumors

摘要: 胰十二指肠切除术(Pancreaticoduodenectomy, PD)是治疗胰头恶性肿瘤的主要手段，被认为是普外科难度最高的手术之一，其疗效直接影响患者的生存率和生活质量。最先开展的方式为传统开放性胰十二指肠切除术(Open Pancreaticoduodenectomy, OPD)。此后，随着微创技术的进步，腹腔镜胰十二指肠切除术(Laparoscopic Pancreatoduodenectomy, LPD)逐渐成为治疗胰头恶性肿瘤的重要方式；近年来，机器人技术的引入进一步推动了手术微创化的发展，机器人胰十二指肠切除术(Robotic Pancreaticoduodenectomy, RPD)已逐步应用于临床。本文将系统阐述胰十二指肠切除术的概述、手术方法的演进，重点分析影响患者预后的关键因素，深入探讨术后常见并发症如胰瘘和出血的定义、危险因素、预防及治疗策略，并对该领域未来的发展方向进行展望，旨在为胰腺恶性肿瘤的外科治疗提供全面的参考。

Abstract: Pancreaticoduodenectomy (PD) is a primary treatment for malignant tumors of the pancreatic head and is considered one of the most challenging surgeries in general surgery. Its effectiveness directly impacts patients' survival and quality of life. The first approach developed was the traditional open pancreaticoduodenectomy (OPD). Subsequently, with the advancement of minimally invasive techniques, laparoscopic pancreaticoduodenectomy (LPD) has gradually become an important treatment method for pancreatic head malignancies; in recent years, the introduction of robotic technology has further propelled the evolution of minimally invasive surgery, and robotic pancreaticoduodenectomy (RPD) has been increasingly adopted in clinical practice. This article will systematically outline an overview of pancreaticoduodenectomy, the evolution of surgical methods, and focus on analyzing the key factors affecting patient prognosis. It will also explore common postoperative complications such as pancreatic fistula and bleeding, including their definitions, risk factors, prevention, and treatment strategies, and will provide a perspective on the future development of this field, aiming to offer a comprehensive reference for the surgical treatment of pancreatic malignancies.