腹腔镜和开腹胰十二指肠切除术治疗远端胆管癌的围术期和预后评价

Perioperative and prognostic evaluations of laparoscopic versus open pancreaticoduodenectomy for distal cholangiocarcinoma

目的比较腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)和开腹胰十二指肠切除术(open pancreaticoduodenectomy,OPD)治疗远端胆管癌的围术期及预后指标是否存在差异。方法回顾性分析吉林大学第二医院2017年6月至2022年5月行胰十二指肠切除术的180例远端胆管癌病人的临床资料,根据手术方式分为LPD组(112例)和OPD组(68例),观察两组病人的手术时间、术中出血量、术后住院时间、R0切除率、淋巴结清扫数目、淋巴结转移比例、淋巴结转移病人阳性淋巴结数目、术后主要并发症的发生率和预后是否存在差异。结果LPD组的手术时间明显长于OPD组[(373.22±80.53)min比(320.86±75.05)min],但术中出血量明显少于OPD组[(325.92±369.33)mL比(510.23±598.30)mL],术后病人住院时间明显短于OPD组[(12.32±4.81)d比(15.30±4.99)d],差异均有统计学意义(均P<0.05)。LPD组和OPD组的术后主要并发症发生率、Clavien-Dindo分级、R0切除率、淋巴结清扫数目、淋巴结转移比例、阳性淋巴结数目和术后总体生存率相比较,差异均无统计学意义(均P>0.05)。结论LPD可以明显减少术中的出血量,缩短病人术后的住院时间。LPD在术后主要并发症的发生率、淋巴结清扫的效果等围术期指标及病人预后方面与OPD相当。

Objective To compare the difference of perioperative and prognostic indices between laparoscopic and open pancreaticoduodenectomy for distal cholangiocarcinoma.Methods From June 2017 to May 2022,clinical data were retrospectively reviewed for 180 patients with distal cholangiocarcinoma undergoing pancreaticoduodenectomy.They were assigned into LPD group(n=112)and OPD group(n=68)according to surgical approaches.Operative duration,intraoperative blood loss,postoperative length of hospital stay,R0 resection rate,count of lymph nodes dissected,proportion of lymph node metastasis,count of positive metastatic lymph nodes,incidence of major postoperative complications and outcomes were observed between two groups.Results Operative duration of LPD group was significantly longer than that of OPD group[(373.22±80.53)vs.(320.86±75.05)min].However,intraoperative blood loss was significantly lower than that of OPD group[(325.92±369.33)vs.(510.23±598.30)mL].And postoperative hospital stay was significantly shorter than that in OPD group[(12.32±4.81)vs.(15.30±4.99)days,P<0.05].No significant inter-group differences existed in the incidence of major postoperative complications,Clavien-Dindo grades,R0 resection rate,count of dissected lymph nodes,proportion of metastatic lymph node,count of positive lymph nodes and overall postoperative survival rate(P>0.05).Conclusion LPD can significantly reduce intraoperative blood loss and shorten postoperative hospital stay.LPD is comparable to OPD in the incidence of major postoperative complications,the efficacy of lymph node dissection and other perioperative indices and patient outcomes.