腹腔镜胰十二指肠切除术（LPD）因操作复杂、出血风险高而被视为胰腺外科的高难度术式，其安全开展依赖于术前精准评估、术中精细操作及围手术期规范化管理。本文对我国LPD的关键技术难点及手术质量控制要点进行逐一剖析，探讨改进方案。术前评估通常包括可切除性评估和肿瘤学评估，除了进行常规精准的腹部增强CT及血管三维重建以评估可切除性并制定手术预案以外，严谨把握肿瘤标志物水平对改善患者预后亦具重大意义。此外，根据肿瘤位置、肿瘤与重要血管的关系选择合适的手术入路，必要时应采用多种手术入路完成手术。血管切除重建及动脉鞘剥除应严格把握适应证，并由经验丰富的胰腺外科团队开展。另外，胰肠吻合方式应依据胰管直径和胰腺质地个体化选择，同时辅以胰管支架以降低胰瘘风险。术后引流液监测及精准处理胰瘘、出血等并发症，条件允许时早拔管以贯彻加速康复外科理念。未来，随着术中导航技术及人工智能的不断发展，LPD有望实现操作标准化、模块化，其安全性有望进一步提升。手术机器人也将是我国下一代胰腺外科领域改革发展的方向之一。

Laparoscopic pancreaticoduodenectomy (LPD) is regarded as a highly demanding procedure in pancreatic surgery due to its complexity and high risk of bleeding. Its safe implementation relies on precise preoperative evaluation, meticulous intraoperative manipulation, and standardized perioperative management. This paper systematically analyzes the key technical difficulties and surgical quality control points of LPD in China, and explores strategies for improvement. Preoperative evaluation generally includes resectability assessment and oncological evaluation. In addition to routine and accurate contrast-enhanced abdominal computed tomography (CT) and three-dimensional vascular reconstruction for assessing resectability and formulating surgical plans, rigorous monitoring of tumor marker levels is also of great significance for improving patient prognosis.

Furthermore, an appropriate surgical approach should be selected according to the tumor location and its relationship with major blood vessels; if necessary, a combination of multiple approaches can be adopted to complete the operation. Indications for vascular resection and reconstruction as well as arterial sheath dissection must be strictly followed, and these procedures should be performed by an experienced pancreatic surgery team. In addition, the method of pancreaticojejunostomy should be individualized based on the diameter of the pancreatic duct and the texture of the pancreatic parenchyma, with the placement of a pancreatic stent to reduce the risk of pancreatic fistula. Postoperative management involves monitoring of drainage fluid, precise treatment of complications such as pancreatic fistula and bleeding, and early removal of drainage tubes when conditions permit, in line with the concept of enhanced recovery after surgery (ERAS).

In the future, with the continuous development of intraoperative navigation technology and artificial intelligence, LPD is expected to achieve standardized and modularized operations, further improving its safety. Surgical robotics will also be one of the directions for the reform and development of pancreatic surgery in China in the next generation.