微创与开放胰十二指肠切除术围手术期预后的初步比较  

Preliminary comparison of perioperative outcomes between minimally invasive and open pancreatoduodenectomy

作　　者：陈鹏[1] 周斌 孙传东[1] 邱法波[1] 张炳远[1] 郭卫东[1] 徐永政 谈震 宋孟锜 曹景玉[1] 胡维昱[1] 韩冰[1] 张顺[1] 吴力群[1] 王祖森[1] 胡骁[1] 田蓝天 冯玉杰[1] 邹浩[1] 朱呈瞻 吴泽华 马凯[1] CHEN Peng;ZHOU Bin;SUN Chuan-dong(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院,山东青岛266003

出　　处：《腹腔镜外科杂志》2018年第9期700-704,共5页Journal of Laparoscopic Surgery

摘　　要：目的:比较腹腔镜与开放胰十二指肠切除术围手术期临床疗效。方法:回顾分析2015年7月至2018年7月为96例患者行胰十二指肠切除术的临床资料,根据手术方式将患者分为微创组与开放组。对比分析两组患者术前情况(年龄、性别、黄疸、BMI、CA19-9、淋巴结有无肿大、术前合并症)、术中情况(手术时间、出血量)、术后相关指标(首次排气时间、首次进食时间、住院时间、肺部感染、切口感染、胰瘘、胃瘫、术后出血、死亡等)。根据学习曲线进一步将微创组分为初期组与进步组,比较两亚组术中及术后相关指标。结果:微创组与开放组术前临床资料差异均无统计学意义(P>0.05)。微创组手术时间长于开放组(P<0.05),术中出血量、住院时间、术后死亡率、胃瘫发生率及Clavien-Dindo分级3/4级并发症评分两组差异无统计学意义(P>0.05),微创组术后排气时间、进食时间及术后肺部感染、切口感染、胰瘘发生率优于开放组(P<0.05),但术后出血发生率高于开放组(P<0.05)。微创组两亚组中,进步组术中出血量少于初期组(P<0.05)。结论:与开放胰十二指肠切除术相比,微创胰十二指肠切除术安全、可行,不仅可有效缩短胃肠道功能恢复时间,还能减少肺部、切口相关并发症,降低胰瘘发生率。但微创手术难度大,手术时间长,术后出血发生率高,对术者技术要求较高。在突破技术节点、跨越较长的学习曲线后,微创胰十二指肠切除术是较好的选择。Objective:To compare the efficacy of laparoscopic and open pancreaticoduodenectomy in perioperative period.Methods:A retrospective analysis was made on the clinical data of 96 patients who underwent pancreaticoduodenectomy from Jul.2015 to Jul.2018 in the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University.Patients were divided into minimally invasive and open groups depending on the surgical procedure.Comparative observation indicators included preoperative conditions(age,gender,jaundice,BMI,CA19-9,lymph node enlargement,preoperative comorbidity),intraoperative conditions(operative time,bleeding volume),postoperative conditions and complications(first exhaust time,first eating time,hospital stay,lung infection,wound infection,pancreatic fistula,gastroparesis,postoperative bleeding,death and so on).Minimally invasive group were further divided into starting period and progressive period two subgroups according to the learning curve.The intraoperative and postoperative conditions of these two subgroups were compared.Results:There was no significant difference in preoperative data between the patients in the minimally invasive group and the open group(P>0.05).The operation time of the minimally invasive group was significantly longer than that of the open group(P<0.05).There were no significant differences in intraoperative blood loss,hospital stay,postoperative mortality,incidence of gastroparesis and Clavien-Dindo grade 3/4 complications(P>0.05).The postoperative exhaust time and eating time of the minimally invasive group were significantly earlier than those of the open group(P<0.05).The incidence of postoperative lung infection,wound infection and pancreatic fistula in the minimally invasive group was better than that in the open group(P<0.05),but the incidence of postoperative bleeding in the minimally invasive group was relatively higher than that in the open group(P<0.05).The bleeding volume in the progressive period was significantly less than that in the starting p

关 键 词：胰十二指肠切除术 腹腔镜检查 剖腹术 预后 对比研究 

分 类 号：R657.5[医药卫生—外科学]