腹腔镜手术与开腹手术治疗壶腹周围恶性肿瘤近期效果的初步观察  

Preliminary observation on the short-term efficacy of laparoscopic and open pancreaticoduodenectomy in the treatment of periampullary malignant tumors

作　　者：程俊峰 厉学民 吴晓康 袁晖[1] 俞世安 Cheng Junfeng;Li Xuemin;Wu Xiaokang;Yuan Hui;Yu Shi′an(Department of Hepatopancreatobiliary Surgery,Jinhua Hospital,Affiliated to Zhejiang University School of Medicine,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属金华医院肝胆胰外科一区,321000

出　　处：《中华外科杂志》2020年第12期918-923,共6页Chinese Journal of Surgery

基　　金：浙江省医药卫生科技计划项目平台重点资助项目(2018ZD052);金华市科技局重大专项(2018-3-001a)。

摘　　要：目的比较腹腔镜胰十二指肠切除术(LPD)和传统胰十二指肠切除术(OPD)治疗壶腹周围恶性肿瘤的近期效果。方法回顾性分析2013年1月至2018年2月在浙江大学医学院附属金华医院肝胆胰外科接受LPD或OPD手术的127例患者的临床资料。男性73例,女性54例;年龄(61.2±9.4)岁(范围:37~80岁)。采用倾向性评分匹配法对两组患者进行1∶1匹配。采用t检验、χ2检验或Fisher确切概率法比较两组患者术后的近期效果。利用Kaplan-Meier法计算总体生存率并绘制生存曲线,通过Log-rank检验比较两组患者围手术期资料的差异。结果经倾向性评分匹配后,两组各有32例患者。OPD组男性21例,女性11例,年龄(62.1±9.3)岁;LPD组男性21例,女性11例,年龄(63.7±9.4)岁。匹配后两组患者的年龄、性别、体重指数等临床资料具有可比性(P值均>0.05)。匹配后LPD组和OPD组的手术时间[M(QR)]分别为381(47)min和249(92)min(t=-5.949,P=0.000),手术费用分别为(6.5±0.7)万元和(5.6±0.9)万元(t=-3.464,P=0.001),术中出血量分别为(249.4±91.4)ml和(329.7±120.3)ml(t=3.008,P=0.004),术后首次排气时间分别为(3.4±1.1)d和(5.0±1.7)d(t=5.316,P=0.000),术后住院时间分别为(18.6±5.6)d和(21.9±5.5)d(t=2.242,P=0.018)。两组术后近期并发症发生率及病理学资料的差异均无统计学意义(P值均>0.05)。匹配后两组术后1年累积总体生存率分别为60.0%和62.0%,差异无统计学意义(P=0.729)。结论LPD可较安全地应用于壶腹周围恶性肿瘤的治疗,具有创伤小、患者康复快的优势,且能达到与开腹手术相似的淋巴结清扫效果和近期效果。Objective To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery,Jinhua Hospital,Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected.Totally 127 patients were included in the study.There were 73 males and 54 females,aged(61.2±9.4)years(range:37-80 years).Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy.Perioperative outcomes and overall survival were compared between the two groups using t test,χ2 test,Fisher exact probability,Kaplan-Meier curve and Log-rank test,respectively.Results A total of 32 pairs of patients were successfully matched by propensity score matching.There were 21 males and 11 females in open pancreaticoduodenectomy group,aged(62.1±9.3)years,21 males and 11 females in laparoscopic group,aged(63.7±9.4)years.Comparion with open pancreaticoduodenectomy,the laparoscopic group had longer operative time(381(47)minutes vs.249(92)minutes)(t=-5.949,P=0.000),higher hospitalization cost((64.8±7.2)thousand yuan vs.(56.0±9.2)thousand yuan,t=-3.464,P=0.001),but less in estimated blood loss((249.38±91.40)ml vs.(329.69±120.26)ml)(t=3.008,P=0.004),shorter in the time to first flatus((3.39±1.1)days vs.(5.03±1.65)days,t=5.316,P=0.000)and preoperative hospital stay((18.6±5.59)days vs.(21.9±5.5)days)(t=2.242,P=0.018).There was no significant difference in vascular invasion,nerve invasion,number of lymph nodes dissected,perioperative complications and pathology(all P>0.05).After PSM,there was no significant difference found in 1-year overall survival rate(60.0%vs.62.0%,P=0.729).Conclusions Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampulla

关 键 词：胰十二指肠切除术 腹腔镜 壶腹周围肿瘤 胰腺肿瘤 治疗结果 倾向性匹配分析 

分 类 号：R735.0[医药卫生—肿瘤]