单孔+13D腹腔镜胰十二指肠切除术的临床疗效  

Clinical efficacy of single‐incision plus one‐port 3D laparoscopic pancreaticoduodenectomy

作　　者：武国[1] 徐建[1] 杨刚[1] 李伟男[1] 张立鑫 赵开烽 英保 李敬东[1] Wu Guo;Xu Jian;Yang Gang;Li Weinan;Zhang Lixin;Zhao Kaifeng;Ying Bao;Li Jingdong(The First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Institute of Hepatobiliary‐Pancreatic‐Intestinal of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院肝胆外一科川北医学院肝胆胰肠疾病研究所,南充637000

出　　处：《中华消化外科杂志》2024年第5期739-745,共7页Chinese Journal of Digestive Surgery

基　　金：四川省自然科学青年基金(22NSFSC0211)。

摘　　要：目的探讨单孔+13D腹腔镜胰十二指肠切除术(SILPD+1)的临床疗效。方法采用回顾性队列研究方法。收集2023年1—10月川北医学院附属医院收治的40例行3D腹腔镜胰十二指肠切除术患者的临床病理资料;男24例,女16例;年龄为(63±10)岁。40例患者中,18例行SILPD+1,设为SILPD+1组;22例行传统5孔法3D腹腔镜胰十二指肠切除术(CLPD),设为CLPD组。观察指标:(1)手术情况。(2)术后及并发症情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用Mann⁃Whitney秩和检验。结果(1)手术情况。SILPD+1组患者中,17例顺利施行手术,1例为胰头炎性肿块,与肠系膜血管分界不清晰,周围组织粘连严重,中转开腹;CLPD组患者均顺利施行手术,无中转开腹;两组患者中转开腹比较,差异无统计学意义(P>0.05)。两组患者术中出血量、术中输血、手术时间比较,差异均无统计学意义(P>0.05)。(2)术后及并发症情况。两组患者肿瘤长径、术中清扫淋巴结数目、阳性淋巴结数目、R0切除、肿瘤病理学类型、术后首次肛门排气时间、术后首次进食流质食物时间、术后首次下床活动时间、术后引流管拔除时间、术后住院时间、术后出血、胰瘘、乳糜漏、胃排空延迟、腹腔积液、切口感染、并发症分级比较,差异均无统计学意义(P>0.05)。SILPD+1组和CLPD组患者术后疼痛评分分别为5.0(4.5,6.0)分和6.5(6.0,7.0)分,两组比较,差异有统计学意义(Z=-3.61,P<0.05)。两组患者术后均无胆瘘、腹腔感染发生;均无术后30 d内再入院、术后90 d内死亡。结论与CLPD比较,SILPD+1安全、可行,术后疼痛更轻,保证肿瘤学疗效的情况下,并未增加手术时间、术后住院时间及术后并发症发生率。Objective To investigate the clinical efficacy of single-incision plus one-port three dimensional(3D)laparoscopic pancreaticoduodenectomy(SILPD+1).Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients who underwent 3D laparoscopic pancreaticoduodenectomy in Affiliated Hospital of North Sichuan Medical College from January to October 2023 were collected.There were 24 males and 16 females,aged(63±10)years.Of the 40 patients,18 cases undergoing SILPD+1 were divided into the SILPD+1 group,and 22 cases under-going conventional five-trocar 3D laparoscopic pancreaticoduodenectomy(CLPD)were divided into the CLPD group.Observation indicators:(1)surgical situations;(2)postoperative situations and complications.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent t test.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data was conducted using the Mann-Whitney rank sum test.Results(1)Surgical situations.Seventeen patients of the SILPD+1 group completed surgery successfully,and the rest of one patient with an inflammatory mass of the pancreatic head was converted to open surgery due to unclear boundary with mesenteric blood vessels and severe adhesion of surrounding tissues.All patients of the CLPD group completed surgery successfully,without conversion to open surgery.There was no significant difference in conversion to open surgery between the two groups(P>0.05),and there was no significant difference in the volume of intraoperative blood loss,intraoperative blood transfusion or operation time(P>0.05).(2)Postoperative situations and complications.There was no significant difference in tumor diameter,the number of lymph node dissected,the num

关 键 词：胰十二指肠切除术 单孔+1 3D 腹腔镜检查 疗效 

分 类 号：R657.5[医药卫生—外科学]