腹腔镜胰十二指肠切除术疗效与安全性的单中心回顾性分析  

Efficacy and safety of laparoscopic pancreatoduodenectomy:a single-center retrospective analysis

作　　者：冯道夫 李琪[1] 沙元朴 李楠[1] 杨学武[1] 田伟军[1] FENG Daofu;LI Qi;SHAYuanpu;LI Nan;YANG Xuewu;TIAN Weijun(Department of General Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院普通外科,天津300052

出　　处：《中国普通外科杂志》2022年第3期295-303,共9页China Journal of General Surgery

基　　金：天津市卫生健康科技人才培育基金资助项目(KJ20037)。

摘　　要：背景与目的:随着腹腔镜技术的发展与普及,腹腔镜胰十二指肠切除术(LPD)也逐渐在临床开展,但由于LPD手术难度大,其效果与安全性方面仍存在一定程度的不确定性。因此,本研究通过对笔者中心实施LPD及同期实施开放胰十二指肠切除术(OPD)患者的临床资料行回顾性分析,进一步评价LPD的近期疗效与安全性。方法:收集2019年2月—2021年9月于天津医科大学总医院普通外科行LPD与OPD患者的资料,比较两组患者围手术期的相关临床指标。结果:根据标准共纳入160例患者进行分析,其中LPD组57例,OPD组103例。两组在年龄、性别、体质量指数(BMI)及术前化验指标等方面差异均无统计学意义(均P>0.05)。LPD组的中位手术时间明显长于OPD组(450 min vs.400 min,P=0.003),而两组术中输血率和术中出血量以及病灶大小等方面差异均无统计学意义(均P>0.05)。此外,患者的BMI对两种术式相关指标无明显影响(均P>0.05)。LPD组术后中位住院时间明显短于OPD组(12 d vs.27 d,P<0.001),术后胃排空障碍发生率明显低于OPD组(5.6%vs.33.7%,P=0.002);两组术后病理、术后第3天引流液淀粉酶含量以及其他术后并发症发生率、二次手术、死亡等差异均无统计学意义(均P>0.05)。LPD组门静脉切除重建的患者(8例)与OPD组门静脉切除重建的患者(12例)比较,前者的手术时间和住院时间明显延长,术中出血量明显增加(均P<0.05)。结论:LPD与OPD具有相似的近期疗效和安全性,且LPD在术后住院时间与术后胃排空障碍发生率方面优于OPD。但LPD手术时间较长,尤其联合行血管重建时,术中出血量更大,术后住院时间更长。LPD对术者手术操作技术上要求较高,这也给了进一步探索并规范化这一复杂术式极大动力。Background and Aims:With the development and popularity of laparoscopic techniques,laparoscopic pancreatoduodenectomy(PD)has been gradually adopted in the clinical setting.However,because of the challenging surgical difficulty of LPD,its efficacy and safety have some degree of uncertainty.Therefore,this study was performed to further assess the short-term efficacy and safety of LPD through a retrospective analysis of the clinical data of patients undergoing LPD and those undergoing open pancreatoduodenectomy(OPD)during the same period.Methods:The data of patients undergoing LPD and OPD in the Department of General Surgery,Tianjin Medical University General Hospital from February 2019 to September 2021 were collected.The main clinical variables were compared between the two groups of patients.Results:A total of 160 patients meeting the eligibility criteria were included for analysis,with 25 cases in LPD group and 103 cases in OPD group.There were no significant differences in terms of age,body mass index(BMI),preoperative testing parameters between two groups(all P>0.05).The median operative time in LPD group was significantly longer than that in OPD group(450 min vs.400 min,P=0.003),while other surgical variables that included blood transfusion rate,intraoperative blood loss,and lesion size showed no statistical difference between the two groups(all P>0.05).In addition,the BMI of the patients exerted no significant influences on the variables associated with the two procedures(all P>0.05).The median length of postoperative hospital stay was shortened(12 d vs.27 d,P<0.001)and the incidence of postoperative delayed gastric emptying was reduced in LPD group compared with OPD group(5.6%vs.33.7%,P=0.002),and there were no statistical differences with regard to the postoperative TNM stage,postoperative pathological results,and concentration of amylase in drainage fluid on postoperative day 3 as well as the incidence rates of other postoperative complications,repeated operation and patients’death between the two group

关 键 词：胰十二指肠切除术 腹腔镜 手术中并发症 手术后并发症 

分 类 号：R657.5[医药卫生—外科学]