腹腔镜辅助下胰十二指肠切除术在十二指肠乳头癌治疗中的应用与评价  

Application and Evaluation of Laparoscopy-assisted Pancreaticoduodenectomy in Duodenal Papillary Carcinoma

作　　者：周凡[1] 黄明文[1] 徐智[1] 罗志强[1] 邹书兵[1] 邵江华[1] 王恺[1] 

机构地区：[1]南昌大学第二附属医院肝胆外科,南昌市330006

出　　处：《中国肿瘤临床》2011年第3期166-169,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨腹腔镜辅助下胰十二指肠切除术治疗十二指肠乳头癌的可行性及其疗效。方法:总结本院17例确诊为十二指肠乳头癌已行胰十二指肠切除术患者的围手术期的临床资料,其中腹腔镜辅助下胰十二指肠切除术(laparoscopically-assistedpancreaticoduodenctomy,LAPD)7例,开腹手术患者(open pancreaticoduodenectomy,OPD)10例。分析手术方法、术中出血量、手术时间、术中难点及对策、术后恢复情况等相关指标。结果:LAPD组平均手术时间为(334.29±32.07)min,与OPD组比较差异无统计学意义(P=0.053),LAPD组手术时间和身体质量指数成正相关(r=-0.809.P=0.028)。而两组中平均失血量,输血例数、切口平均长度、平均首次离床活动时间、平均肠鸣恢复时间、平均住院时间等比较差异均有统计学意义(P均<0.05),LAPD组均优于OPD组,两组术后并发症差异无统计学意义。结论:腹腔镜辅助下胰十二指肠切除术在十二指肠乳头癌的临床应用中是安全可行的,具有一定的优势,肿瘤位置合适、体型偏瘦的病例是开展该术式的理想条件。Objective： To explore the feasibility and efficacy of laparoscopically assisted pancreaticoduodenctomy （ LAPD ） in patients with duodenal papillary carcinoma. Methods： Clinical data of 17 patients with duodenal papillary carcinoma who underwent pancreaticoduodenectomy were reviewed. Of the 17 cases, laparoscopy-assisted pancreaticoduodenctomy （ LAPD ） was conducted in 7 cases and open pancreaticoduodenectomy （ OPD ） was performed in 10 cases. Various indices including the surgical method, intraoperative blood loss, duration of surgery, intraoperative difficulties, and postoperative recovery were analyzed. Results： There were no significant differences in general clinicopathologic data, including the age and sex distribution, body mass index, tumor size, or pathology staging between the groups. The mean duration of surgery in the LAPD group （ 334.29±32.07 min ） was similar to that in the OPD group （ 287.00±52.72 min, P = 0.053 ）, without statistical differences between the two groups. There was a positive correlation between the surgical duration and body mass index in the LAPD group （ r = 0.809, P = 0.028 ）. However, there were statistically significant differences between the two groups in mean blood loss [ （ 112.86±62.64 ） mL vs. （ 266.50 60.28 ）.mL ], the number of cases requiring intraoperative transfusion （ 1 vs. 4 ）, incision length [ （ 7.87±1.79 ） cm vs. （ 15.20±1.62 ） cm ], average time to first ambulation [ （ 4.14± 0.69 ） d vs. （ 5.10±0.57 ） d], time to borborygmus recovery [ （ 3.57±0.79 ） d vs. （ 4.40±0.70 ） d ], and length of postoperative hospital stay[ （ 17.57±3.69 ） d vs. （ 20.80±2.25 ） d ] （ P〈 0.05 ）. All data were better in the LAPD group than in the OPD group. No significant differences in the postoperative complications were found between the two groups. Conclusion： Laparoscopy-assisted pancreaticoduo- denectomy for selected cases with duodenal papillary carcinoma is feasible and safe, and has a definit

关 键 词：腹腔镜 胰十二指肠切除术 十二指肠乳头癌 

分 类 号：R735.3[医药卫生—肿瘤]