动脉优先入路在腹腔镜胰十二指肠切除术中的临床价值  

Clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy

作　　者：马春阳[1] 朱峰[1] 王敏[1] 彭丰[1] 张航[1] 郭兴军[1] 冯业晨[1] 王贺彬[1] 秦仁义[1] Ma Chunyang Zhu Feng Wang Min Peng Feng Zhang Hang Guo Xingjun Feng Yechen Wang Hebin Qin Renyi.(Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华消化外科杂志》2017年第8期832-838,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81602475、81502633、81402443）;国家“十一五”支撑项目（2006BA102A13-402）

摘　　要：目的：探讨动脉优先入路在腹腔镜胰十二指肠切除术（LPD）中的应用价值。方法：采用回顾性队列研究方法。收集2014年10月至2016年12月华中科技大学同济医学院附属同济医院收治的181例行LPD的胰头颈部癌和壶腹周围癌患者的临床病理资料。181例患者中，96例行动脉优先入路的LPD，设为实验组；85例行传统入路的LPD，设为对照组。两组患者手术均由同一手术团队完成，手术切除范围、淋巴结清扫范围及消化道重建方式均相同。观察指标：（1）术中情况。（2）术后情况。（3）随访及生存情况。采用门诊和电话方式进行随访，随访内容为患者无瘤生存情况。随访时间截至2017年2月。正态分布的计量资料以±s表示，组间比较采用t检验；偏态分布的计量资料采用M（范围）表示。计数资料比较采用X2检验。结果：（1）术中情况：两组患者均顺利完成LPD。实验组和对照组患者总手术时间分别为（268±20）min和（285±25）min，消化道重建时间分别为（33±10）min和（30±17）min，两组患者上述指标比较，差异均无统计学意义（t=8.529，2.741，P〉0.05）。实验组和对照组患者肿瘤切除时间，有肠系膜上静脉侵犯分别为（216±13）min和（264±22）min，两组比较，差异有统计学意义（t=41.826，P〈0.05）；无肠系膜上静脉侵犯分别为（224±14）min和（215±21）min，两组比较，差异无统计学意义（t=7.423，P〉0.05）。实验组和对照组患者术中出血量分别为（99±16）mL和（131±27）mL，术中输血量分别为（1.3±0.8）U和（2.8±1.2）U，两组患者上述指标比较，差异均有统计学意义（t=3.670，0.562，P〈0.05）；术中输血例数分别为5、8例，两组比较，差异无统计学意义（X2=1.195，P〉0.05）。（2）术后情况：实验组和对照组患者术后引流管拔除时间分别为（5.8±2.4）d和（6.3±3.6）d，术后住�Objective：To investigate the clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy （LPD）. Methods：The retrospective cohort study was conducted. The clinicopathological data of 181 patients with pancreatic head and periampullay tumors who underwent LPD in the Affiliated Tongji Hospital of Huazhong University of Science and Technology between October 2014 and December 2016 were collected. Among 181 patients, 96 using arterial first approach and 85 using traditional approach were respectively allocated into the experimental group and the control group. Surgery was applied to patients in the same doctors′ team, and there were the same extent of surgical resection, range of lymph node dissection and digestive tract reconstruction. Observation indicators： （1） intraoperative situation; （2） postoperative situation; （3） followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect the tumorfree survival up to February 2017. Measurement data with normal distribution were represented as ±s, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M （range）. Comparison of count data were analyzed using the chisquare test or Fisher exact probability. Results： （1） Intraoperative situation： all the patients underwent successful LPD. Overall operation time and time of digestive tract reconstruction were respectively （268±20）minutes, （33±10）minutes in the experimental group and （285±25）minutes, （30±17）minutes in the control group, with no statistically significant difference between 2 groups （t=8.529, 2.741, P〉0.05）. Time of tumor resection with superior mesenteric venous invasion were respectively （216±13）minutes and （264±22）minutes in the experimental and control groups, with a statistically significant difference between the 2 groups （t=41.826, P〈0.05）. Time of tumor resection without superior mesenter

关 键 词：胰腺肿瘤 壶腹周围肿瘤 动脉优先入路 动脉优先离断 胰十二指肠切除术 腹腔镜检查 

分 类 号：R656[医药卫生—外科学]