微创肿瘤剜除术治疗胰腺良性及低度恶性肿瘤60例效果分析  

Minimally invasive enucleation for benign and low-grade malignant pancreatic tumors:an analysis of 60 cases

作　　者：刘梦奇 刘文生 李征 卓奇峰 吉顺荣 许文彦 史逸华 虞先濬 徐晓武 Liu Mengqi;Liu Wensheng;Li Zheng;Zhuo Qifeng;Ji Shunrong;Xu Wenyan;Shi Yihua;Yu Xianjun;Xu Xiaowu(Department of Pancreatic Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Pancreatic Cancer Institute,Pancreatic Cancer Institute,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院胰腺外科,复旦大学上海医学院肿瘤学系,上海市胰腺肿瘤研究所,复旦大学胰腺肿瘤研究所,上海200032

出　　处：《中华外科杂志》2022年第7期674-679,共6页Chinese Journal of Surgery

基　　金：上海市卫生健康委员会卓越项目(20224Z0006);上海市科学技术委员会扬帆专项(22YF1409000);上海市科技重大专项(21JC1401500);上海市教委科技创新项目(2019-01-07-00-07-E00057);上海医院发展中心临床研究计划(SHDC2020CR1006A);上海市抗癌协会雏鹰计划(SACA-CY21C03)。

摘　　要：目的探讨微创肿瘤剜除术治疗胰腺良性及低度恶性肿瘤的可行性。方法回顾性收集2019年11月至2021年8月复旦大学附属肿瘤医院胰腺外科收治的60例行微创胰腺肿瘤剜除术的良性及低度恶性肿瘤患者的临床和病理学资料。男性17例,女性43例,年龄(50.0±13.2)岁(范围:23~73岁)。肿瘤位置位于胰头部40例(66.7%),胰颈体尾部20例(33.3%)。根据手术方式不同,分为机器人组(n=25)和腹腔镜组(n=35)。定量资料使用t检验或Mann-WhitneyU检验进行比较,分类资料采用χ^(2)检验或Fisher确切概率法进行比较,使用单因素和多因素Logistic回归分析术后胰瘘的影响因素。结果所有患者均顺利完成肿瘤剜除术,无中转开腹,手术时间(183.5±67.3)min(范围:90~410 min),12例(20.0%)患者术中行支架置入胰管修补,术后腹腔引流管拔除时间(24.7±22.9)d(范围:2~113 d)。机器人组的肿瘤最大径大于腹腔镜组[(3.5±0.9)cm比(2.9±0.7)cm,t=-2.825,P=0.006],术后生化漏及B级胰瘘发生率分别为20.0%、22.9%和36.0%、51.4%(χ^(2)=2.289,P=0.318)。两组均无C级胰瘘发生,亦无淋巴瘘、胆瘘、胃排空延迟、二次手术和围手术期死亡。对有无发生临床相关胰瘘进行多因素Logistic回归分析,结果显示,体重指数大(OR=1.285,95%CI:1.053~1.569,P=0.014)、肿瘤最大径大(OR=3.703,95%CI:1.465~9.360,P=0.006)、术中行胰管修补(OR=7.889,95%CI:1.471~42.296,P=0.016)是发生胰瘘的独立危险因素,而手术方式中的机器人手术(OR=0.168,95%CI:0.036~0.796,P=0.025)为胰瘘的保护因素。随访观察无患者出现胰酶依赖的消化不良和新发糖尿病。结论微创肿瘤剜除术治疗胰腺良性和低度恶性肿瘤是可行的,术后短期内胰瘘的发生率较高,但少见严重并发症。机器人辅助手术在减少术后胰瘘和处理较大肿瘤方面具有优势。Objective To investigate the safety and feasibility of minimally invasive pancreatic tumor enucleation.Methods The clinicopathological data of 60 patients with minimally invasive pancreatic tumor enucleation admitted to the Department of Pancreatic Surgery of Fudan University Cancer Center from November 2019 to August 2021 were retrospectively analyzed.There were 17 males and 43 females,with age of(50.0±13.2)years(range:23 to 73 years).Tumors were located in the head of pancreas in 40 cases(66.7%),neck and tail of pancreas in 20 cases(33.3%).Patients were divided into robotic group(n=25)and laparoscopic group(n=35)according to surgical methods.The measurement data were compared by t-test or Mann-Whitney U test,and the categorical data were compared byχ^(2) test or Fisher exact probability method.The influencing factors of postoperative pancreatic fistula were analyzed by univariate and multivariate Logistic regression.Results All patients successfully completed tumor enucleation without conversion to laparotomy.The operation time was(183.5±67.3)minutes(range:90 to 410 minutes).Twelve patients(20.0%)underwent stent placement and pancreatic duct repair during operation.The removal time of abdominal drainage tube after operation was(24.7±22.9)days(range:2 to 113 days).The tumor diameter in the robotic group was larger than that in the laparoscopic group((3.5±0.9)cm vs.(2.9±0.7)cm,t=-2.825,P=0.006).The incidences of postoperative biochemical fistula and grade B pancreatic fistula were 20.0%,22.9%and 36.0%,51.4%,respectively(χ²=2.289,P=0.318).There were no grade C pancreatic fistula,lymphatic fistula,biliary fistula,delayed gastric emptying,secondary operation and perioperative death in both groups.Multivariate logistic regression analysis was performed on the occurrence of clinically related pancreatic fistula(above grade B).The results showed that the increase of body mass index(OR=1.285,95%CI:1.053 to 1.569,P=0.014),the larger diameter of the tumor(OR=3.703,95%CI:1.465 to 9.360,P=0.006)and intraoperative pa

关 键 词：胰腺肿瘤 外科手术 微创性 剜除 机器人手术 并发症 

分 类 号：R735.9[医药卫生—肿瘤]