腹腔镜与开放胰十二指肠切除术治疗胰腺良性与低度恶性肿瘤的近期疗效分析  

Comparison of perioperative outcomes between laparoscopic and open pancreaticoduodenectomy for benign and low-grade malignant pancreatic lesions

作　　者：陈卫波[1] 汤天逾 张悦[1] 安勇[1] 谭煜炜 陈学敏[1] CHEN Wei-bo;TANG Tian-yu;ZHANG Yue(Department of Hepatopancreatobiliary Surgery,the First People's Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)

机构地区：[1]常州市第一人民医院,苏州大学附属第三医院肝胆胰外科,江苏常州213003

出　　处：《腹腔镜外科杂志》2020年第9期641-645,共5页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金(81602054);常州市科技局应用基础研究项目(CJ20190093);常州市卫生健康委重大科技项目(ZD201906);江苏省卫生健康委高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2019022)。

摘　　要：目的:比较腹腔镜胰十二指肠切除术(LPD)与开腹胰十二指肠切除术(OPD)治疗胰腺良性与低度恶性肿瘤的近期疗效。方法:回顾分析2009年12月至2020年4月行LPD或OPD且术后病理证实为胰腺良性或低度恶性肿瘤的75例患者的临床资料。对比分析两组术前、术中、术后及病理资料。结果:75例手术均获成功,LPD组无中转开放。LPD组手术时间长于OPD组[(352.7±85.5)min vs.(273.5±65.4)min,P<0.001],LPD组术中出血量[(201.2±117.1)mL vs.(401.2±310.0)mL,P<0.001]、术后住院时间[(14.3±5.4)d vs.(18.4±5.6)d,P=0.002]优于OPD组。两组术中输血率、术后首次进流质饮食时间、二次手术率及术后胰瘘、出血、胆漏及胃排空障碍等主要并发症发生率差异无统计学意义。两组患者术后病理资料存在一定差异,OPD组具有更多的慢性胰腺炎病例(P=0.035)。结论:与OPD相比,LPD治疗胰腺良性与低度恶性肿瘤手术时间更长,但具有术中出血少、术后住院时间短的优势。Objective:To compare the short-term outcomes of laparoscopic pancreaticoduodenectomy(LPD)and open pancreaticoduodenectomy(OPD)in the treatment of benign and low-grade malignant pancreatic lesions.Methods:The clinical data of 75 patients with LPD or OPD who were diagnosed with benign or low-grade malignant pancreatic lesions from Jan.2010 to Apr.2020 were analyzed retrospectively.The differences in perioperative and pathological data between the two groups were compared.Results:All the 75 cases of surgeries were completed successfully,and no conversion was conducted in the LPD group.The operation time in the LPD group was significantly longer than that of the OPD group[(352.7±85.5)min vs.(273.5±65.4)min,P<0.001].The intraoperative blood loss[(201.2±117.1)mL vs.(401.2±310.0)mL,P<0.001]and the postoperative hospital stay[(14.3±5.4)d vs.(18.4±5.6)d,P=0.002]was less in the LPD group than that in the OPD group.There was no significant difference in intraoperative transfusion rate,the time to initiate oral intake,the incidence of reoperation and major complications such as pancreatic fistula,bleeding,bile leakage,and delayed gastric emptying.The pathology was different between the two groups,with the OPD group including more chronic pancreatitis(P=0.035).Conclusions:Though the LPD procedure has a longer operation time,it has advantages of less intraoperative bleeding and shorter postoperative hospital stay in managing benign and low-grade malignant pancreatic lesions when compared to OPD.

关 键 词：胰腺肿瘤 胰十二指肠切除术 腹腔镜检查 剖腹术 疗效比较研究 

分 类 号：R735.9[医药卫生—肿瘤]