腹腔镜与开腹胰十二指肠切除术的安全性和疗效对比研究

doi:10.3969/j.issn.1009-976X.2022.02.002

摘要/Abstract

摘要： 目的比较腹腔镜胰十二指肠切除术（LPD）和开腹胰十二指肠切除术（OPD）的安全性和疗效。方法回顾性分析2016年1月至2021年8月期间施行胰十二指肠切除术患者的临床资料,将符合标准的49例患者分成LPD组（n=23）和OPD组（n=26）,比较两组患者的手术时间、术中出血量、术后并发症、术后住院时间、术后肿瘤学结果及预后等方面的差异。结果 LPD和OPD两种术式的术中输血率和术后胰瘘、胆瘘、术后出血、胃排空延迟、腹腔感染、并发症发生率等手术安全性指标相近（P>0.05）;LPD组较OPD组手术时间延长,但术中出血量减少（P<0.05）。两种术式术后入住ICU人数、非计划再次手术人数、标本肿瘤长径、术中淋巴结清扫数目、淋巴结阳性患者例数、R0切除率、肿瘤分化程度、术后病理分期、肿瘤来源、出院30 d内再次入院率、术后复发率、术后90 d死亡率及术后1年、2年、3年生存率等手术疗效指标相近（P>0.05）。与OPD相比,LPD术后首次下床活动时间和肛门排气时间提早,术后住院日缩短,术后疼痛评分降低和基本日常生活活动能力评分提高（P<0.05）。结论与OPD相比,LPD安全可靠,可获得同样的肿瘤学根治效果,手术疗效值得肯定,在临床上是可行的。

关键词: 胰腺癌, 壶腹周围癌, 胰十二指肠切除术, 安全性, 疗效

Abstract: Objective To compare the safety and efficacy of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Methods The clinical data of patients who underwent pancreaticoduodenectomy from January 2016 to August 2021 were analyzed retrospectively. Forty-nine patients who met the criteria after PD were divided into LPD group （n=23） and OPD group （n=26）. The operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay, postoperative oncology results and prognosis were compared between the two groups. Results In terms of surgical safety, the intraoperative blood transfusion rate, incidence of postoperative pancreatic fistula, biliary fistula, postoperative bleeding, delayed gastric emptying, abdominal infection and complication rate in LPD group were similar to that in OPD group, and the differences were not statistically significant （P>0.05）.Compared with OPD, LPD had a longer operation time, but less intraoperative blood loss（P<0.05）. In terms of surgical efficacy, the number of patients admitted to ICU, the number of unplanned reoperations, the length of tumor specimens, the number of intraoperative lymph node dissection, the number of patients with positive lymph nodes, the rate of R0 resection, the degree of tumor differentiation, postoperative pathological stage, tumor origin, readmission rate within 30 days after discharge, postoperative recurrence rate, postoperative 90-day mortality, postoperative 1-year,2-year and 3-year survival rates of LPD were similar to that of OPD,and the differences were not statistically significant （P>0.05）. Compared with OPD, the first time of getting out of bed and anal exhaust after LPD were earlier, the postoperative hospital stay was shorter, the postoperative pain score was lower, and the basic daily living ability score was higher（P<0.05）. Conclusion Compared with OPD, LPD is safe and reliable, and can obtain the same radical effect of oncology. The curative effect of LPD is worth affirming, and it is feasible in clinic

Key words: pancreatic cancer, periampullary adenocarcinoma, pancreaticoduodenectomy, safety, efficacy

中图分类号:

R735.9

邓静, 陈焕伟. 腹腔镜与开腹胰十二指肠切除术的安全性和疗效对比研究[J]. 岭南现代临床外科, 2022, 22(02): 120-125.

DENG Jing, CHEN Huan-wei. Comparative study on the safety and efficacy of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy[J]. Lingnan Modern Clinics In Surgery, 2022, 22(02): 120-125.

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