达芬奇机器人与开腹胰十二指肠切除术临床疗效比较  

Comparison of clinical efficacy between da Vinci robotic and open pancreaticoduodenectomy

作　　者：胡剑翀 邹浩[1] 朱呈瞻 吴泽华 宋孟锜 马凯[1] 韩冰[1] 孙传东[1] Hu Jianchong;Zou Hao;Zhu Chengzhan;Wu Zehua;Song Mengqi;Ma Kai;Han Bing;Sun Chuandong(Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肝胆胰外科,266003

出　　处：《中华腔镜外科杂志（电子版）》2021年第2期75-80,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的比较达芬奇机器人胰十二指肠切除术(robotic pancreaticoduodenectomy,RPD)与开腹胰十二指肠切除术(open pancreaticoduodenectomy,OPD)的临床疗效。方法回顾性分析2016年5月至2018年5月期间在青岛大学附属医院肝胆胰外科完成的26例RPD患者及70例OPD患者围手术期的临床和病理学资料,对比分析两组患者的临床指标。结果相较于OPD组,RPD组的手术时间长[(450.65±93.74)min比(322.40±84.04)min,P<0.001],术中出血量少[225.0 ml(142.5 ml,312.5 ml)比350.0 ml(200.0 ml,562.5 ml),P<0.001]、术中输血率低(7.7%比27.1%,P=0.040)。RPD组的术后排气时间[(5.27±1.40)d比(6.36±1.83)d,P=0.007]、术后进流食时间[(6.35±1.33)d比(8.09±2.08)d,P<0.001]、术后住院时间[14.00 d(12.00 d,24.75 d)比18.00 d(14.00 d,28.25 d),P=0.043]短于OPD组,但住院总费用[11.80万元(9.56万元,15.27万元)比8.81万元(7.28万元,12.47万元),P=0.004]高于OPD组。两组拔除胃管时间、拔除腹腔引流管时间、术后并发症发生率、二次手术率、术后30 d病死率、术后病理结果比较,均差异无统计学意义(P>0.05)。结论相较于OPD,RPD创伤小、术中出血量少、术中输血率低、术后住院时间短、恢复快,但手术时间长、住院费用高。RPD不但具有与OPD相当的并发症发生率,而且同样能够实现肿瘤根治性切除,RPD术式安全、可行,未来将有更好的应用和发展前景。Objective To compare the clinical efficacy of da Vinci robotic pancreaticoduodenectomy(RPD)and open pancreaticoduodenectomy(OPD)in perioperative period.Methods A retrospective analysis was performed on the perioperative clinical and pathological data of 26 patients receiving RPD and 70 patients receiving OPD from May 2016 to May 2018 in Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University.The main clinical indices during the perioperative period were compared and analyzed among the two groups of patients.Results The RPD group had longer operative time[(450.65±93.74)min(322.40±84.04)min,P<0.001],less intraoperative bleeding[225.0 ml(142.5 ml,312.5 ml)350.0 ml(200.0 ml,562.5 ml),P<0.001]and lower transfusion rate(7.7 vs 27.1%,P=0.040),compared to OPD group.The postoperative exhaust time[(5.27±1.40)d(6.36±1.83)d,P=0.007],feeding time[(6.35±1.33)d(8.09±2.08)d,P<0.001]and hospitalization time[14.00 d(12.00 d,24.75 d)18.00 d(14.00 d,28.25 d),P=0.043]in RPD group were both shorter than those in OPD group,but the total cost of hospitalization was higher than that in OPD group[118.0 thousands yuan(95.6 thousands yuan,152.7 thousands yuan)88.1 thousands yuan(72.8 thousands yuan,124.7 thousands yuan),P=0.004].There were no significant differences in the removal time of gastric tube and abdominal drainage tube,postoperative complications rate,reoperation rate,postoperative 30 d death rate and postoperative pathological results between the two groups(P>0.05).Conclusions Compared with OPD,RPD has advantages such as less surgical trauma,less bleeding,lower transfusion rate,shorter postoperative hospital stay and more rapid recovery time,despite the longer operative time and higher hospitalization cost.RPD not only has the comparable incidence of complications compared with OPD,but also can achieve radical resection.It is safe and feasible and will have better application and development in the future.

关 键 词：胰十二指肠切除术 达芬奇机器人 临床疗效 

分 类 号：R47[医药卫生—护理学]