腹腔镜远端胰腺切除术与开腹远端胰腺切除术对比分析

Comparative study of laparoscopic and open distal pancreatectomy

目的对比分析腹腔镜远端胰腺切除术(LDP)与开腹远端胰腺切除术(ODP)术中及术后资料,探讨LDP的可行性、安全性及与临床疗效。方法回顾性分析2011年5月至2012年2月68例远端胰腺切除术患者的临床资料,其中LDP组16例,ODP组52例,比较两组基线情况、术中及术后情况。结果两组均无死亡病例。LDP组与ODP组患者性别比例、年龄、体质量指数、肿瘤直径及住院总费用差异均无统计学意义。LDP组与ODP组手术切口长度分别为(3.50±1.34)cm和(17.94±2.12)cm,手术时间分别为(145.63±56.80)min和(87.21±32.06)min,两组切口长度、手术时间差异有统计学意义(P<0.001)。LDP组与ODP组术后住院时间分别为(5.06±1.24)d和(8.06±2.53)d,术后卧床时间分别为(1.31±0.68)d和(2.94±0.80)d,术后禁食时间分别为(1.31±0.57)d和(2.86±1.34)d,两组术后住院时间、卧床时间、禁食时间差异均有统计学意义(P<0.001)。两组术中失血量分别为(318.75±227.21)ml和(306.35±378.36)ml,差异无统计学意义(P=0.898)。LDP组术后并发胰漏4例(25.00%),腹腔积液1例(6.25%);ODP组术后并发胰漏12例(23.08%),腹腔积液3例(5.77%),其中有1例同时发生胰漏和腹腔积液;两组间胰漏及腹腔积液发生率差异均无统计学意义。LDP组术后疼痛指数多分布于1～2级,而ODP组多分布于2～3级,两组差异有统计学意义(P<0.001)。结论 LDP用于治疗胰腺体尾部良性或交界性疾病是安全可行的,与常规开腹手术相比,LDP具有创伤轻、痛苦小、恢复快等优势,且并未增加总住院费用。

Objective To assess the feasibility, safety and efficacy of laparoscopic distal pancreatectomy （LDP） by comparing LDP with open distal panereatectomy （ODP）. Methods The clinical data of 68 patients with pancreatic body or tail diseases, who received distal pancreatectomy from May 2011 to February 2012, were retrospectively analyzed. LDP was performed in 16 cases and ODP in 52 cases. The baseline clinical data and the intraoperative and postoperative findings were compared between the two groups. Results There was no death in the two groups. The sex ratio, age, body mass index, tumor diameter and total hospital costs were not significantly different between the two groups. The incision length of LDP group was significantly shorter than that of ODP group （[3. 50±1.34] cm vs [17. 94±2.12] cm, P〈0. 001）. The operative duration of LDP group was significantly longer than that of ODP group （[145. 63±56. 80] min vs [87. 21 ±32. 06] min, P〈0. 001）. Postoperative hospital stay of LDP and ODP groups were （5.06±1.24） d and （8.06±2.53） d （P〈0. 001）, time in bed after surgery were （1. 31±0. 68） d and （2. 94±0. 80） d （P〈0. 001）, and postoperative fasting time were （1.31±0.57） d and （2. 86±1.34） d （P〈0. 001）, respectively. Estimated blood loss of LDP and ODP groups were （318. 75± 227. 21） ml and （306. 35±378.36） ml （P=0. 898）, respectively. Four patients had pancreatic leakages and 1 had peritoneal effusion in LDP group. Twelve patients had pancreatic leakages and 3 had peritoneal effusions in ODP group, with one having both pancreatic leakage and peritoneal effusion. There were no significant differences in the incidence of pancreatic leakage and peritoneal effusion between the two groups. The postoperative pain score was mainly 1-2 in LDP group and 2-3 in ODP group, with significant differences found between the two groups （P〈0. 001）. Conclusion LDP is feasible and safe in treating benign or borderline disease of pancreatic body and tail. Compared to ODP, LDP has the advantage of less trauma and pain, quicker recovery without increasing the total costs.