机器人胰十二指肠切除术学习曲线后开展腹腔镜胰十二指肠切除术的疗效分析  

Clinical efficacy of laparoscopic pancreaticoduodenectomy after the learning curve of robotic-assisted pancreaticoduodenectomy

作　　者：翁原驰[1] 赵良超[1] 谢俊杰[1] 叶靳华[1] 沈柏用[1] 彭承宏[1] 邓侠兴[1] Weng Yuanchi;Zhao Liangchao;Xie Junjie;Ye Jinhua;Shen Baiyong;Peng Chenghong;Deng Xiaxing(Department of General Surgery,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《加速康复外科杂志》2021年第2期67-72,共6页JOURNAL OF ENHANCED RECOVERY AFTER SURGERY

摘　　要：目的:对比机器人胰十二指肠切除术(robotic-assisted pancreaticoduodenectomy,RPD)和度过RPD学习曲线后开展腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)的近期疗效。方法:采用回顾性研究,收集2013年1月至2020年12月在上海交通大学医学院附属瑞金医院进行微创胰十二指肠切除术的635例患者的临床病理资料,对615例RPD(RPD组)和20例LPD(LPD组)从手术情况、术后病理情况、术后近期疗效等指标进行统计分析比较,并对LPD患者进行分阶段参数比较。结果:手术情况对比,RPD组与LPD组患者中转开腹率分别为2.1%(13/615)和15.0%(3/20)(P=0.012);手术时间分别为300.0(240.0,350.0)min和410.0(335.0,500.0)min(P<0.001),差异有统计学意义;术中出血量、输血率差异无统计学意义。术后病理结果对比,RPD组与LPD组中恶性肿瘤患者分别为381例(62.0%)和17例(85.0%)(P=0.036),差异有统计学意义;胰腺导管腺癌比例、静脉受累切除率、肿瘤大小、R0切除率、受检淋巴结数等差异均无统计学意义。术后并发症率对比,RPD组与LPD组胰瘘分别为105例(17.1%)和7例(35.0%)(P=0.038),出血分别为12例(2.0%)和4例(20.0%)(P<0.001),差异有统计学意义;B、C级胰瘘,以及胆瘘、感染、胃排空延迟、再次手术、围手术期死亡、术后住院天数等方面差异无统计学意义。第1阶段LPD和第2阶段LPD比较,手术时间分别为490.0(450.0,533.5)min和345.0(300.0,392.5)min(P=0.004);术中出血量分别为250(100,650)ml和100(50,225)ml(P=0.049),差异有统计学意义。结论:度过RPD学习曲线后开展LPD,可以取得较好的手术结果及近期疗效,学习曲线缩短。Objective:To compare the short-term outcomes of robotic-assisted pancreaticoduodenectomy(RPD)and laparoscopic pancreaticoduodenectomy(LPD)after the RPD learning curve.Methods:The clinicopathological data of 635 patients who underwent minimally invasive pancreaticoduodenectomy in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2013 to December 2020 were collected retrospectively.The intraoperative data,postoperative pathological results and short-term outcomes were analyzed and compared between 615 RPD cases and 20 LPD cases.And the data of LPD patients were compared by stages.Results:The conversion to laparotomy rate of RPD group and LPD group were 2.1%(13/615)and 15.0%(3/20)(P=0.012);the operation time were 300.0(240.0,350.0)min and 410.0(335.0,500.0)min(P<0.001),with a statistically significant difference;but there was no statistical difference in intraoperative blood loss and blood transfusion rate.The pathological results showed that the malignant tumors in RPD group and LPD group were 381(62.0%)and 17(85.0%)respectively(P=0.036),with statistical difference;there was no statistical difference in pancreatic ductal adenocarcinoma rate,the vein invasion rate,tumor size,R0 resection rate and the number of examined lymph nodes.The postoperative pancreatic fistula rates of RPD group and LPD group were 105(17.1%)and 7(35.0%)respectively(P=0.038),and the postpancreatectomy hemorrhage were 12(2.0%)and 4(20.0%)respectively(P<0.001),both with statistical difference;there was no statistical difference in grade B and C pancreatic fistula,biliary fistula,infection,delayed gastric emptying,reoperation,perioperative mortality and postoperative stay.In the first stage LPD cases and the second stage LPD cases,the operation time were 490.0(450.0,533.5)min and 345.0(300.0,392.5)min(P=0.004);the intraoperative blood loss were 250(100,650)ml and 100(50,225)ml(P=0.049),with statistical difference.Conclusion:After the RPD learning curve,LPD can achieve acceptable surgical results and short-

关 键 词：腹腔镜胰十二指肠切除术 机器人胰十二指肠切除术 学习曲线 

分 类 号：R657.5[医药卫生—外科学]