腹腔镜保留十二指肠的胰头切除术的围手术期疗效研究  

Perioperative efficacy of laparoscopic duodenal-preserving pancreatic head resection

作　　者：尹韬远 汪小祥 张航 郭兴军 王敏[1] 秦仁义[1] Yin Taoyuan;Wang Xiaoxiang;Zhang Hang;Guo Xingjun;Wang Min;Qin Renyi(Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华外科杂志》2024年第7期671-676,共6页Chinese Journal of Surgery

基　　金：国家重点研发计划(2022YFA1105300-03);国家自然科学基金(82273442, 82073249, 82273438);中国博士后科学基金(2023M731201);湖北省重点研发计划(2021BCA117);同济医院临床研究领航项目(2019TFC1315905)。

摘　　要：目的比较腹腔镜保留十二指肠的胰头切除术(LDPPHR)与腹腔镜胰十二指肠切除术(LPD)治疗胰头交界性肿瘤及良性疾病的围手术期效果。方法本研究为回顾性队列研究。回顾性收集2020年1月至2022年12月华中科技大学同济医学院附属同济医院胆胰外科通过LDPPHR或LPD治疗的87例胰头交界性肿瘤及良性疾病患者的围手术期资料。男性49例, 女性38例, 年龄[M(IQR)]57.0(16.5)岁(范围:20~75岁)。其中40例接受LDPPHR, 47例接受LPD。正态分布的定量资料采用Student′st检验进行比较, 非正态分布的定量资料采用Mann-WhitneyU检验进行比较, 分类变量的比较采用χ^(2)检验或Fisher确切概率法。使用Logistic回归分析估计与并发症发生相关的危险因素。结果 LDPPHR组和LPD组患者的再手术率、总住院时间、术后住院时间、90 d病死率、30 d及90 d再入院率和2年肿瘤复发率的差异均无统计学意义(P值均>0.05)。LDPPHR组的围手术期并发症发生率高于LPD组[80.0%(32/40)比51.1%(24/47);χ^(2)=7.89, P=0.005], 但两组Clavien-Dindo并发症分级系统≥Ⅲ级并发症发生率的差异无统计学意义[10.0%(4/40)比12.8%(6/47);χ^(2)<0.01, P=0.947]。LDPPHR组患者的胃排空延迟(DGE)发生率高于LPD组(χ^(2)=10.79, P=0.001), 但两组B、C级DGE发生率的差异无统计学意义(χ^(2)=0.48, P=0.487)。在术后胰瘘、胆瘘、胰腺术后出血、腹腔感染、肺部感染等并发症发生率方面, 两组差异均无统计学意义(P值均>0.05)。单因素Logistic回归分析结果表明, LDPPHR(参照LPD, OR=3.83, 95%CI:1.46~10.04, Z=2.73, P=0.006)和术前胆管支架置入(参照不使用胆管支架, OR=5.30, 95%CI:1.13~25.00, Z=2.11, P=0.035)是总体并发症发生的危险因素, 但两者均不是总体并发症发生的独立危险因素(P值均>0.05)。结论初步研究结果显示, 在治疗胰头交界性及良性疾病方面, LDPPHR可获得与LPD相当的围手术期安全性和有效性。Objective:To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR)with laparoscopic pancreaticoduodenectomy(LPD)in the treatment of borderline and benign diseases of the pancreatic head.Methods:This is a retrospective cohort study.Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022.There were 49 male and 38 female patients with an age(M(IQR))of 57.0(16.5)years(range:20 to 75 years).Forty patients underwent LDPPHR and 47 patients underwent LPD.Quantitative data following a normal distribution were compared using Student′s t-test,while quantitative data not following a normal distribution were compared using the Mann-Whitney U test.Comparisons of categorical or ordinal variables were made usingχ^(2) test or Fisher′s exact test.Logistic regression analysis was used to estimate the risk factors associated with the rate of complications.Results:There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate(all P>0.05).The complication rate was higher in the LDPPHR group compared to the LPD group(80.0%(32/40)vs.51.1%(24/47),χ^(2)=7.89,P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications≥Ⅲbetween the two groups(10.0%(4/40)vs.12.8%(6/47),χ^(2)<0.01,P=0.947).Additionally,the rate of delayed gastric emptying(DGE)was higher in the LDPPHR group compared to the LPD group(χ^(2)=10.79,P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups(χ^(2)=0.48,P=0.487).There were no statistically sig

关 键 词：胰腺肿瘤 胰十二指肠切除术 胰腺交界性肿瘤 腹腔镜保留十二指肠的胰头切除术 腹腔镜胰十二指肠切除术 

分 类 号：R735.9[医药卫生—肿瘤]