手助腹腔镜技术在胰体尾切除术中的应用

Application of hand-assisted laparoscopic distal pancreatectomy

目的:探讨手助腹腔镜胰体尾切除术的安全性和有效性。方法:回顾分析2002年9月至2009年12月施行的10例手助腹腔镜胰体尾切除术与14例开腹胰体尾切除术的临床资料。结果:腹腔镜组手术切口[(4.8±0.8)cm]显著短于开腹组[(14.4±2.6)cm](P<0.001),术中出血量[(116.0±64.8)m l]少于开腹组[(328.6±314.8)m l](P=0.048),术后恢复肛门排气时间[(2.8±0.6)d]显著短于开腹组[(3.9±0.7)d](P=0.002),术后恢复饮食时间[(3.7±0.7)d]显著短于开腹组[(4.7±0.8)d](P=0.001),术后住院时间[(9.5±4.2)d]显著短于开腹组[(12.7±2.7)d](P=0.033)。而两组手术时间、术后并发症发生率差异无统计学意义。结论:手助腹腔镜胰体尾切除术患者创伤小,手术时间短,术后康复快,是治疗胰体尾肿瘤安全、可行的方法。

Objective：The aim of this study was to evaluate the safety and efficacy of hand-assisted laparoscopic distal pancreatectomy（HLDP） and compare it with open distal pancreatectomy（open-DP）.Methods：Twenty-four patients who underwent distal pancreatectomy（HLDP,10 patients;open-DP,14 patients） between Sep.2002 and Dec.2009 in department of general surgery of Shanghai Changzheng Hospital were enrolled in this study.Their clinical data were compared.Results：The incision for HLDP group[（4.8±0.8）cm] was significantly shorter than that in the open-DP group[（14.4±2.6）cm]（P0.001）.Blood loss in the HLDP group [（116.0±64.8） ml] was significantly less than that in the open-DP group [（328.6±314.8）ml]（P=0.048）.And,none of the patients in the HLDP group received conversions.The average time of first passage of flatus[（2.8±0.6）d vs.（3.9±0.7）d;P=0.002],time of oral intake[（3.7±0.7）d vs.（4.7±0.8）d;P=0.001] and hospital stay [（9.5±4.2）d vs.（12.7±2.7）d;P=0.033）] in the HLDP group were significantly shorter than those in the open-DP group.The operative time and the incidence of postoperative complications in HLDP and open-DP groups were not significantly different.Conclusions：HLDP for distal pancreatic neoplasms is safe and feasible.The procedure appears to be mini-invasive and rapid,and it is accompanied by an accelerated recovery.