实质离断优先在机器人辅助胰体尾切除术中的应用  

Application of parenchymal priority secure ligation in robotic distal pancreatectomy

作　　者：李嘉诚 肖均喜 王道斌 薛小峰[1] 秦磊[1] 侍阳[1] 张伟刚[1] Li Jiacheng;Xiao Junxi;Wang Daobin;Xue Xiaofeng;Qin Lei;Shi Yang;Zhang Weigang(Department of General Surgery,the First Affiliated Hospital of Suzhou University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院普外科,215000

出　　处：《中华普通外科学文献（电子版）》2023年第4期245-251,共7页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的分析实质离断优先的机器人胰体尾切除术(PPRDP)对比应用直线切割闭合器的腹腔镜胰体尾切除术(S-LDP)在短期疗效上是否具备优势。方法回顾性分析2017年1月至2022年12月苏州大学附属第一医院接受微创手术切除的胰体尾部占位患者116例,其中PPRDP组38例,S-LDP组78例。收集并对比两组患者的基本资料、围手术期检验结果及影像学资料、术中情况和术后并发症发生率。结果PPRDP组较S-LDP组的手术时间更长[(275±70)min vs(240±66)min,P=0.010]、住院总费用更高(79009元vs 57921元,P<0.001),但具有更低的B/C级术后胰瘘发生率(18.4%vs 37.2%,P=0.040)以及更短的术后住院时间(7 d vs 9 d,P=0.001)。特别是在胰尾部肿瘤中,PPRDP体现出更低的术中出血量及更多的胰腺实质保留量(均P<0.05)。结论PPRDP安全可行,相较于S-LDP手术具有更低的术后胰瘘发生率和更高的保脾效率。对于肿瘤位于胰腺尾部者,PPRDP在保证可靠切缘的同时保留更多的胰腺实质,为胰腺功能的保护提供组织基础。Objective To compare and analyze the short-term efficacy of parenchymal priority robotic distal pancreatectomy(PPRDP)with laparoscopic pancreatectomy using stapler(S-LDP).Methods From January 2017 to December 2022,116 patients with distal pancreatic lesions who underwent surgical resection in the First Affiliated Hospital of Suzhou University were retrospectively analyzed,including 38 patients in the PPRDP group and 78 patients in the S-LDP group.The basic data,perioperative data,intraoperative conditions,and postoperative complications were collected and compared.Results Compared with group S-LDP,group PPRDP had longer operation time[(275±70)min vs(240±66)min,P=0.010]and higher total hospitalization costs(79009 yuan vs 57921 yuan,P<0.001),but lower incidence of postoperative pancreatic fistula(18.4%vs 37.2%,P=0.040)and shorter postoperative hospital stays(7 d vs 9 d,P=0.001).Especially in pancreatic tail tumors,PPRDP exhibited lower intraoperative blood loss and more pancreatic parenchymal retention(both P<0.05).Conclusions PPRDP has more reliable sealing effect on pancreatic stumps and can reduce the incidence of postoperative pancreatic fistula than S-LDP.For patients with tumors located in the tail of the pancreas,PPRDP can ensure a negative surgical margin while retaining more pancreatic parenchyma,which may reduce the damage to pancreatic function in patients.

关 键 词：胰体尾切除 机器人 腹腔镜 术后胰瘘 

分 类 号：R657.5[医药卫生—外科学]