保留器官功能的胰腺手术近期并发症和远期生活质量评价  

The evaluation of the short-term operative complications and the long-term quality of life of the organ-preserving pancreatectomy

作　　者：唐雨辰 张子祥[1] 伍星 易彬[1] 汤耀程 杨健[1] 高鑫 李德春[1] 周健[1] Tang Yuchen;Zhang Zixiang;Wu Xing;Yi Bin;Tang Yaocheng;Yang Jian;Gao Xin;Li Dechun;Zhou Jian(Department of General Surgery,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院普通外科、苏州大学附属第一医院胰腺疾病研究中心,江苏苏州215006

出　　处：《中华胰腺病杂志》2018年第5期318-323,共6页Chinese Journal of Pancreatology

基　　金：江苏省医学重点研发计划（BE2016673）;江苏省医学青年人才计划（QNRC2016734）;苏州市民生科技计划（SS201632）

摘　　要：目的探讨保留器官功能的胰腺手术对患者近期并发症和远期生活质量的影响。方法回顾性分析2013年1月至2016年12月间苏州大学附属第一医院收治的320例胰腺手术患者的临床资料，分为传统手术组和保留器官功能的胰腺手术组。传统手术组包括胰十二指肠切除术（PD）、胰体尾部切除术（DP）和腹腔镜下胰体尾部切除术（LDP）；保留器官功能的胰腺手术组包括保留幽门胰十二指肠切除术（PPPD）、保留脾脏胰体尾切除术（SPDP）、腹腔镜下保留脾脏胰体尾切除术（LSPDP）、胰腺肿瘤剜除术（EP）和胰腺中段切除术（MSP）。采用门诊和电话方式进行随访，每3个月1次，随访时间截止至2017年5月31日。记录患者的手术时间、术中出血和输血量、术后并发症（胰瘘、腹腔感染、出血、胃排空障碍、血糖控制差）发生情况、住院时间、二次手术及术后30 d生存情况，随访患者胰腺内外分泌功能和远期生活质量。结果术中手术时间、出血及输血量方面，PD组与PPPD组、DP组与SPDP组、LDP组与LSPDP组、DP组与MSP组、DP组与EP组间的差异均无统计学意义（P值均〉0.05）。与MSP组比较，DP组的住院时间缩短[（18.6±12.5）d比（26.9±15.2）d]，术后胰瘘（24.07%比56.25%）、腹腔感染（1.85%比18.75%）、出血（3.70%比25.00%）、胃排空障碍（5.56%比31.25%）、二次手术（0比25.00%）发生率减少，但血糖控制差（27.78%比0），差异均有统计学意义（P值均〈0.05）。出院后PD组慢性腹泻发生率高于PPPD组（17.31%比2.08%），DP组疲劳者多于SPDP、MSP及EP组，LDP组疲劳者多于LSPDP组，但社会功能和总体健康者评分均低于LSPDP组，差异均有统计学意义（P值均〈0.05）。结论保留器官功能的胰腺手术能减少手术的创伤，降低术后并发症发生率，减少术后胰腺内外分泌功能不足的发生，改善患者远期生活质量�Objective To discuss the effect of main organ-preserving pancreatectomy operations on the postoperative complications and the long-term quality of life.Methods The clinical data of 320 patients undergoing pancreatic surgery from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University were retrospectively analyzed and all the patients were divided into traditional pancreatectomy surgery group and organ-preserving pancreatectomy surgery group. The traditional pancreatectomy surgery group included pancreaticoduodenectomy （PD）, distal pancreatectomy （DP）, and laparoscopic distal pancreatectomy （LDP）; and the organ-preserving pancreatectomy surgery group included pylorus-preserving pancreaticoduodenectomy （PPPD）, spleen-preserving distal pancreatectomy （SPDP）, enucleation pancreatectomy （EP）, and middle-preserving pancreatectomy （MSP）. Face to face clinic visit or telephone follow-up was scheduled every three months until May 31, 2017. The operation time, intraoperative hemorrhage, intraoperative blood transfusion, postoperative complications （hemorrhage, pancreatic fistula, biliary fistula, abdominal infection, delayed gastric emptying）, postoperative hospitalization stay, secondary surgery and the survival status within 30 days after surgery, the pancreatic endocrine function, exocrine function and the long-term quality of life were recorded.Results The operation time, intraoperative hemorrhage and intraoperative blood transfusion were not statistically different between PD and PPPD groups, DP and SPDP groups, LDP and LSPDP groups, DP and MSP groups, and DP and EP groups, respectively （all P values 〉0.05）. Compared with MSP group, the hospitalization time in DP group was shorter [（18.61±12.46）d vs （26.88±15.22）d], the occurrence rate of postoperative pancreatic fistula （24.07% vs 56.25%）, bleeding （3.70% vs 25.00%）, abdominal infection （1.85% vs 18.75%）, delayed gastric emptying （5.56% vs 31.25%）, secondary surgery （0 vs 2

关 键 词：胰腺肿瘤 胰腺切除术 保留器官功能 术后并发症 生活质量 

分 类 号：R657.5[医药卫生—外科学]