腹腔镜与传统手术治疗胆总管下段癌的临床疗效对比  

Comparison of Clinical Curative Effect between Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy on Terminal Bile Duct Carcinoma

作　　者：王哲元[1] 张亚武[1] 权柯 

机构地区：[1]兰州大学第二医院胆胰外科,730030

出　　处：《医学研究杂志》2017年第12期143-148,共6页Journal of Medical Research

摘　　要：目的对比腹腔镜胰十二指肠切除术(LPD)与传统开腹胰十二指肠切除术(OPD)治疗胆总管下段癌的临床疗效。方法回顾性分析笔者所在医院普外科于2008年3月~2013年3月期间收住的40例中晚期胆总管下段癌患者的临床资料,行腹腔镜胰十二指肠切除术患者(LPD组)12例,行传统开腹胰十二指肠切除术患者(OPD组)28例。结果 LDP组患者的手术出血量、拔除胃肠减压时间、拔除腹腔引流管时间、术后下床活动时间、术后胃肠蠕动功能恢复时间、术后绝对卧床及住院时间均低(短)于OPD组患者,但LPD组患者的住院费用及手术时间高(长)于OPD组患者(P<0.05)。术后两组共15例患者出现相关并发症,其中,LPD组患者5例,OPD组患者10例,两组的总并发症发生率比较,差异无统计学意义(P>0.05)。其中,LPD组的胆瘘发生率均高于OPD组(P<0.05),而胰瘘、全身感染、肺部感染、切口感染、胃延迟排空的发生率均无异于OPD组(P>0.05)。术后40例患者均随访,随访1~36个月(中位数为27个月)。随访期间,LPD组复发8例,转移6例,死亡8例;OPD组复发18例,转移13例,死亡18例。两组的复发率、转移率及病死率比较,差异无统计学意义(P>0.05)。结论根据目前的研究结果,对于胆总管下段癌患者而言,LPD在术后恢复方面优于OPD,而在减少胆瘘、胰瘘、感染、胃延迟排空等并发症方面以及提高患者生存时间方面与OPD比较差异无统计学意义。但由于两组的样本量相对较小,对本研究结果可能带来一定的偏倚,两种术式的疗效对比仍需更多临床对照研究进一步探讨。Objective To compare the clinical curative effect between laparoscopic pancreaticoduodenectomy （LPD） and open pancreaticoduodenectomy （OPD） in treatment of terminal bile duct carcinoma.Methods Clincal data of 40 patients with advanced terminal bile duct carcinoma who underwent pancreaticoduodenectomy in our hospital from March 2008 to March 2013 were collected, of which 12 patients were in LPD group and 28 patients in OPD group.Results Hospitalization expense and operative time of patients were in LPD group were both more or longer than those of OPD group （P〈0.05）, but haemorrhage, pulling out the drainage tube time, pulling out the stomach tube time, active time post-operation, aeration time, absolute resting on bed time, and hospitalization time in LPD group were lower or shorter than those of OPD group （P〈0.05）. There were 15 patients suffered with postoperative complication, including 5 patients in LPD group and 10 patients in OPD group, and there was no significant difference between the two groups in total incidence of postoperative complication （P〉0.05）. In the specific postoperative complication, the incidences of biliary fistula of LPD group were higher than those of OPD group （P〈0.05）, but incidences of pancreatic fistula, systemic infection, pulmonary infection, incision infection, and delayed gastric emptying between two groups were no significant difference （P〉0.05）. All patients were followed up for 1-36 months with the median time of 27 months. During the follow-up periods, in LPD group, 8 patients suffered with recurrence, 6 patients suffered with tumor metastasis, and 8 patients died; in OPD group, 18 patients suffered with recurrence, 13 patients suffered with tumor metastasis, and 18 patients died. There were no significant difference between two groups in the recurrence rate, metastasis rate, and mortality （P〉0.05）.Conclusion According to the results of the current study, for patients with common bile duct cancer, LPD group was superior to OPD group

关 键 词：胆总管下段癌 胰十二指肠切除术 腹腔镜 传统开腹 临床疗效 

分 类 号：R735.8[医药卫生—肿瘤]