中国普通外科杂志2026，Vol.35Issue(3)：436-445,10.DOI:10.7659/j.issn.1005-6947.260066
微创胰十二指肠切除术:在安全底线之上的根治追求
Minimally invasive pancreaticoduodenectomy:striving for oncologic radicality within the limits of safety
摘要
Abstract
Minimally invasive pancreaticoduodenectomy(MIPD)is transitioning from a stage of technical feasibility toward a phase focused on achieving oncologic radicality while maintaining safety.Current evidence suggests that,in high-volume centers with experienced surgical teams,the perioperative safety of MIPD is comparable to that of open pancreaticoduodenectomy.However,its safety profile is influenced not only by the surgical approach,but also by institutional qualification,surgeon experience,case complexity stratification,and the management of key technical steps.Among these,appropriate selection of pancreaticojejunostomy plays a crucial role in reducing complications such as postoperative pancreatic fistula.From an oncologic perspective,MIPD can achieve margin status and R0 resection rates comparable to open surgery.Nevertheless,the persistently high rate of local recurrence and suboptimal long-term survival in pancreatic cancer indicate that true oncologic radicality remains unresolved.Traditional extended resections have not demonstrated clear survival benefits.Emerging concepts such as total mesopancreas excision offer new strategies for improving local control,but their anatomical basis,indications,and clinical value require further validation.With the increasing use of neoadjuvant therapy,inflammation and fibrosis further complicate anatomical identification,margin assessment,and intraoperative decision-making,thereby imposing higher demands on patient selection and surgical judgment.Overall,the evolution of MIPD should extend beyond technical minimal invasiveness toward a more balanced approach that integrates precise patient selection,rigorous difficulty stratification,and robust evidence-based support,aiming to achieve optimal oncologic outcomes without compromising safety.关键词
胰十二指肠切除术/最小侵入性外科手术/学习曲线/新辅助疗法Key words
Pancreaticoduodenectomy/Minimally Invasive Surgical Procedures/Learning Curve/Neoadjuvant Therapy分类
医药卫生引用本文复制引用
卓浚哲,罗琦漤,王敏..微创胰十二指肠切除术:在安全底线之上的根治追求[J].中国普通外科杂志,2026,35(3):436-445,10.基金项目
国家重点研发计划基金资助项目(2024YFA1307304) （2024YFA1307304）
国家自然科学基金资助项目(82472876、82273438) （82472876、82273438）
中国医学科学院医学与健康科技创新工程基金资助项目(2025-I2M-XHJC-014). （2025-I2M-XHJC-014）
