开腹和3D腹腔镜胰体尾联合脾脏切除术的围手术期比较研究  

The perioperative comparative analysis of clinical efficacy between three-dimensional laparoscopic and open distal pancreatectomy combined with splenectomy

作　　者：邢宏松 江帆[1] 吴国俊[1] 黎建军[1] 程彦君 Xing Hongsong;Jiang Fan;Wu Guojun;Li Jianjun;Cheng Yanjun(Department of Hepatobiliary Surgery,Puren Hospital,Wuhan University of Science and Technology,Wuhan 430000,China;Department of Science and Education,Puren Hospital,Wuhan University of Science and Technology,Wuhan 430000,China)

机构地区：[1]武汉科技大学附属普仁医院肝胆外科,武汉430000 [2]武汉科技大学附属普仁医院科教部,武汉430000

出　　处：《腹部外科》2018年第4期270-273,279,共5页Journal of Abdominal Surgery

摘　　要：目的对比分析开腹胰体尾联合脾脏切除术和3D腹腔镜胰体尾联合脾脏切除术治疗胰体尾良恶性肿瘤的围手术期疗效。方法回顾性分析2015年5月至2017年2月已行胰体尾联合脾脏切除术病人的临床资料,根据手术方式不同,分为3D腹腔镜胰体尾联合脾脏切除术组(A组=32例)和开腹胰体尾联合脾脏切除术组(B组=40例)。比较A、B两组术前临床资料、麻醉ASA等级评分、手术相关变量、围手术期并发症发生率、死亡率、住院总费用情况。结果两组病人手术时间分别为(5.8±0.8)h和(4.2±0.9)h,A组长于B组,差异有统计学意义(t=8.283,P=0.000);两组病人术中失血量分别为(272.7±72.2)ml和(460.2±259.0)ml,A组病人少于B组,差异有统计学意义(t=-4.455,P=0.000);A组病人术中输血量和麻醉ASA等级评分与B组比较,差异无统计学意义(P>0.05);两组病人术后住院时间分别为(8.8±2.7)d和(15.9±2.6)d,A组显著短于B组,差异有统计学意义(t=-11.207,P=0.000);A组病人围手术期并发症发生率及死亡率与B组相比,差异均无统计学意义(P>0.05);A组病人住院总费用显著多于B组,分别为(5.97±1.33)万元和(5.08±1.72)万元,但差异无统计学意义(t=0.015,P=2.484)。结论 3D腹腔镜胰体尾联合脾脏切除术与开腹手术相比,虽住院总费用稍多,但术中输血少、术后恢复快,有助于提高病人的治疗效果,值得在临床上推广应用。Objective To comparatively analyze the clinical efficacy between three-dimensional laparoscopic and open distal pancreatectomy（LDP）combined with splenectomy for the treatment of the pancreatic tail benign and malignant tumors in perioperative period.Methods A total of 72 patients undergoing distal pancreatectomy（LDP）combined with splenectomy,who were admitted to our hospital from May 2015 to February 2017,were divided into two groups according to the surgical procedures：dimensional laparoscopic distal pancreatectomy combined with splenectomy group（group A,n=32）and LDP combined with splenectomy group（group B,n=40）.The preoperative clinical data,ASA anesthesia classification,intraoperative related variables,the perioperative complications and death rate were compared.Results The operation time in group A was significantly longer than in group B（5.8±0.8 h vs.4.2±0.9 h,t=8.283,P=0.000）.The intraoperative blood loss in group A was less than in group B（272.7±72.2 mL vs.460.2±259.0 mL,t=-4.455,P=0.000）.The intraoperative blood transfusion volume and ASA anesthesia classification showed no significant difference between group A and group B（P〉0.05）.The postoperative hospital stay in group A was significantly shorter than in group B（8.8±2.7 h vs.15.9±2.6 h,t=-11.207,P=0.000）.There was no significant difference in the postoperative complications between group A and group B（P〉0.05）.The total expenses in group A were greater than those in group B [（5.97±1.33）×104 yuan vs.（5.08±1.72）×104 yuan,t=0.015,P=2.484）.Conclusions Even though 3-dimensional d LDP combined with splenectomy has a great hospital expense,it has less intraoperative blood transfusion and shorter hospital stay,which can help to improve the therapeutic effect of the patients.

关 键 词：胰体尾联合脾脏切除术 疗效 3D腹腔镜 

分 类 号：R612[医药卫生—外科学]