胰十二指肠切除术治疗壶腹部周围疾病的临床疗效(附2 019例报告)  

Clinical efficacy of pancreaticoduodenectomy for periampullary diseases: a report of 2 019 cases

作　　者：吴鹏飞 张凯 陈建敏 陆子鹏 奚春华 郭峰 涂敏 陈国胜 卫积书 肖斌吴峻立 高文涛 戴存才 蔡宝宝 吕楠 尹杰 徐冬 时国东 苗毅 蒋奎荣 Wu Pengfei;Zhang Kai;Chen Jianmin;Lu Zipeng;Xi Chunhua;Guo Feng;Tu Min;Chen Guosheng;Wei Jishu;Xiao Bin;Wu Junli;Gao Wentao;Dai Cuncai;Cai Baobao;Lyu Nan;Yin Jie;Xu Dong;Shi Guodong;Miao Yi(Pancreas Center,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Pancreas Institute of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)胰腺中心,南京医科大学胰腺研究所,南京210029

出　　处：《中华消化外科杂志》2022年第4期483-491,共9页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82072706);江苏省重大疾病生物资源样本库(BM2015004)。

摘　　要：目的:探讨胰十二指肠切除术(PD)治疗壶腹部周围疾病的临床疗效。方法:采用回顾性队列研究方法。收集2016年1月至2020年12月南京医科大学第一附属医院收治的2019例壶腹部周围疾病行PD患者的临床病理资料;男1193例,女826例;年龄为63(15)岁。观察指标:(1)手术情况。(2)术后情况。(3)术后病理学检查情况。(4)壶腹部周围恶性肿瘤预后分析。采用电话和门诊方式对壶腹部周围恶性肿瘤患者定期随访,术后第1年每3个月随访1次,1年后每6个月随访1次,了解患者术后生存情况。随访时间截至2021年12月。偏态分布的计量资料以M(IQR)或M(范围)表示,组间比较采用秩和检验。计数资料以绝对数和(或)百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-Rank检验进行生存分析。结果:(1)手术情况。2019例患者中,2016—2018年收治1116例,2019—2020年收治903例;1866例行开腹PD,153例行腹腔镜或机器人辅助PD;1049例行标准PD,970例行保留幽门的PD;215例行PD联合门静脉-肠系膜上静脉切除;3例行PD联合动脉切除。2019例患者手术时间为255(104)min,术中出血量为250(200)mL,术中输血率为31.401%(623/1984),35例术中输血资料缺失。2016—2018年收治的1116例患者中保留幽门、联合门静脉-肠系膜上静脉切除、术中输血分别为585例(52.419%)、97例(8.692%)、384例(34.941%);2019—2020年收治的903例患者中上述指标分别为385例(42.636%)、118例(13.068%)、239例(27.006%);两者上述指标比较,差异均有统计学意义(χ^(2)=19.14,10.05,14.33,P<0.05)。(2)术后情况。2019例患者术后住院时间为13(10)d。2019例患者中,1例术后并发症资料缺失,2018例术后总体并发症发生率为45.292%(914/2018),其中B级或C级胰瘘发生率为23.439%(473/2018),B级或C级出血发生率为8.127%(164/2018),B级或C级胃排空延迟发生率为15.312%(309/2018),胆瘘发�Objective:To investigate the clinical efficacy of pancreaticoduodenectomy(PD)for periampullary diseases.Methods:The retrospective cohort study was conducted.The clinico-pathological data of 2019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected.There were 1193 males and 826 females,aged 63(15)years.Observation indicators:(1)surgical situations;(2)postoperative conditions;(3)postoperative pathological examinations;(4)prognosis of patients with periampullary carcinoma.Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma.The follow-up was up to December 2021.Measurement data with skewed distribution were represented as M(IQR)or M(range),and comparison between groups was analyzed using the rank sum test.Count data were described as absolute numbers and(or)percentages,and comparison between groups was analyzed by the chi-square test or Fisher exact probability.Kaplan-Meier method was used to draw survival curves and calculate survival rates,and Log-Rank test was used to conduct survival analysis.Results:(1)Surgical situations:of 2019 patients,1116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020.There were 1866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD.There were 1049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD.There were 215 cases combined with portal mesenteric vein resection,3 cases combined with arterial resection.The operation time of 2019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL.The intraoperative blood transfusion rate was 31.401%(623/1984),with the blood transfusion data of 35 cases missing.The proportions of pylorus-preservation,combination with portal mesenteric vei

关 键 词：胰腺肿瘤 十二指肠乳头癌 壶腹癌 十二指肠癌 远端胆管癌 胰十二指肠切除术 并发症 生存 

分 类 号：R657.5[医药卫生—外科学]