腹腔镜胰十二指肠切除术治疗胆总管下段癌围手术期安全性及疗效分析  

Perioperative safety and efficacy of laparoscopic pancreaticoduodenectomy for carcinoma of the lower common bile duct

作　　者：潘冬花 李贵全 巫毓挺 刘贤 骆建美 何姗姗 付金强[2] Pan Donghua;Li Guiquan;Wu Yuting;Liu Xian;Luo Jianmei;He Shanshan;Fu Jinqiang(Department of general surgery,Qionglai Medical Center Hospital,Qionglai Sichuan Province 611530,China;Department of hepatobiliary and pancreatic surgery,Leshan people’s Hospital,Leshan Sichuan Province 614000,China)

机构地区：[1]四川省人民医院·邛崃医院(邛崃市医疗中心医院)普外科,四川邛崃611530 [2]乐山市人民医院肝胆胰外科,四川乐山614000

出　　处：《中华普外科手术学杂志（电子版）》2022年第2期187-191,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省2019年第一批科技计划项目(19KPPX0226);2018年四川省卫生健康科研课题立项项目(18ZD045)。

摘　　要：目的研究腹腔镜胰十二指肠切除术(LPD)治疗胆总管下段癌围手术期安全性及其疗效。方法回顾性分析2015年1月至2019年12月97例行胰十二指肠切除术(PD)治疗胆总管下段癌患者的临床资料。其中,56例行腹腔镜辅助胰十二指肠切除术(LAPD)患者纳入LAPD组,41例行LPD患者纳入LPD组。使用SPSS 24.0统计学软件分析数据,围手术期指标等计量资料以(-x±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验。生存分析采用Kaplan-Meier生存曲线分析。以P<0.05为检验标准。结果LAPD组手术时间及消化道重建时间较LPD组更短,而术中出血量较LPD组更多,且患者术后排气时间较LPD组更长,两组间差异均有统计学意义(P<0.05);两组患者住院时间、淋巴结清扫数目和术后并发症两组间差异均无统计学意义(P>0.05)。所有患者均成功随访,随访时间12~59个月,中位随访时间26个月。两组患者术后1年总生存率(OS)分别为87.3%、87.6%,3年OS分别为46.6%、41.2%,两组间差异无统计学意义(P>0.05)。结论LPD治疗胆总管下段癌安全可行,相较于LAPD有着创伤更小、术后恢复更快等优势,但其操作难度大,术者应在严格培训学习后实践,以保证手术安全性及有效性。Objective To investigate the safety and efficacy of laparoscopic pancreaticoduodenectomy(LPD)in the treatment of the lower common bile duct carcinoma.Methods Data of 97 patients who underwent pancreaticoduodenectomy(PD)for lower common bile duct carcinoma from January 2015 to December 2019 were retrospectively analyzed.Among them,56 patients undergoing laparoscopic assist pancreaticoduodenectomy were included in the LAPD group,and 41 patients undergoing LPD were included in the LPD group.Data were analyzed by SPSS 24.0 statistical software.Perioperative indexes and other measurement data were expressed as(-x±s),and independent sample t test was performed.Postoperative complications were tested byχ^(2) test.Kaplan-Meier survival curve was used for survival analysis.P<0.05 was taken as the test standard.Results Compared with the LPD group,the operation time and digestive tract reconstruction time of the LAPD group were shorter,while the intraoperative blood loss was more than that of the LPD group,and the postoperative exhaust time was longer,with statistical significance between the two groups(P<0.05).There were no significant differences in the length of hospital stay,number of lymph nodes dissected and postoperative complications between two groups(P>0.05).All patients were successfully followed up for 12~59 months,with a median follow-up time of 26 months.The 1-year overall survival rate(OS)was 87.3%and 87.6%,and the 3 years OS was 46.6%and 41.2%,respectively,with no statistical significance between the two groups(P>0.05).Conclusion LPD is safe and feasible in the treatment of carcinoma of the lower common bile duct.Compared with LAPD,LPD has the advantages of less trauma and faster postoperative recovery.However,it is difficult to operate,and the operators should practice it after strict training and learning to ensure the safety and effectiveness of the operation.

关 键 词：胆总管肿瘤 胰十二指肠切除术 腹腔镜 腹腔镜辅助 安全性 

分 类 号：R65[医药卫生—外科学]