中文摘要：

目的总结联合血管切除重建的腹腔镜和达芬奇机器人行根治性胰十二指肠切除术（RPD）患者的经验，探索扩大胰头癌腹腔镜和达芬奇机器人胰十二指肠切除术的适应证。方法自2013年12月至2016年1月，我科共完成67例患者行腹腔镜和达芬奇机器人杂交胰十二指肠切除术，其中有5例联合血管切除重建。回顾性分析5例联合血管切除重建的腹腔镜和达芬奇机器人胰十二指肠切除术患者的临床资料。结果5例患者的平均手术时间为378（360—480）min，平均失血量为360（120～450）ml。其中4例在腹腔镜下行PV／SMV楔形切除修补，未行血流阻断；1例在腹腔镜下完成动脉优先胰十二指肠切除术后，改为机器人节段切除门静脉一肠系膜上静脉端端吻合术，血流阻断时间为35min。术中快速切片和术后常规病理切片报告显示胰头癌伴慢性胰腺炎，血管壁肿瘤侵犯3例，血管壁慢性炎症2例，切缘均为阴性。术后并发胆漏和上消化道出血各1例，A级胰漏1例。除上消化道出血1例行胃镜下止血治愈外，其余患者均保守治疗痊愈，无死亡病例。术后住院时间为14（9—35）d。结论在熟练掌握开腹联合血管切除重建和常规腹腔镜胰十二指肠切除术后，选择性开展联合血管切除重建腹腔镜和达芬奇杂交根治性胰十二指肠切除术是安全有效的。

英文摘要：

Objective To analyze our experience on laparoscopic and Da Vinci robotic radical pan- ereaticoduodenectomy combined with major vascular resection and reconstruction, and to expand the indica- tions of surgery for patients with pancreatic cancer. Methods From December 2013 to January 2016, 67 patients underwent laparoscopic and Da Vinci robotic pancreaticoduodenectomy in our department. The resection was combined with major vein resection in 5 patients. We retrospectively analyzed the clinical data of these patients who had laproscopic or Da Vinci robotic pancreaticoduodenectomy with major vascular resec- tion and reconstruction. Results The mean operation time was 378 （360-480） minutes, and the mean es- timated blood loss was 360 （120 -450） ml. 4 patients underwent laparoscopic wedge-resection of PV/SMV without interruption of blood flow. After pancreaticoduodenectomy using the superior mesentery artery first approach, one patient underwent resection of a segment of portal vein and superior mesenteric vein followed by an end to end anastomosis using the Da Vinci robotic system. The total blood flow occlusion time was 35 minutes. Intraoperative frozen section biopsy and postoperative pathological results were chronic pancreatitis with pancreatic cancer in all these patients. The veins were invaded by tumor in 3 patients. In the remaining 2 patients, the vascular wall showed chronic inflammation. All the surgical resection margins were tumor negative. Postoperative complications included one patient with bile leakage, one patient with upper gastroin- testinal bleeding and one patient with a grade A pancreatic fistula （PF）. The patient with upper gastrointes- tinal bleeding was managed successfully using hemostatic treatment under gastroscopy, and the other patients all recovered well after conservative therapy. There was no death in this study. The mean postoperative hos- pitalization stay was 14 （9-35） days. Conclusions Laparoscopic or Da Vinci robotic radical pancreati-coduodenectomy combined with