保留十二指肠胰头切除术与胰十二指肠切除术治疗慢性胰腺炎的比较研究

Duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy for chronic pancreatitis

目的:比较保留十二指肠胰头切除术(duodenum-preserving pancreatic head resection,DPPHR)与胰十二指肠切除术(pancreaticoduodenectomy,PD)治疗慢性胰腺炎的安全性及临床疗效。方法:回顾分析我院2004年1月至2010年12月接受DPPHR与PD的59例慢性胰腺炎病人,比较两种术式的术前数据、手术情况、术后并发症率、死亡率和术后住院天数等,用EORTC(European Organization for Research and Treatment of Cancer)QLQ-C30(Quality-of-Life Questionnaire-C30)V3.0中文版生活质量评分量表评价术后病人的生活质量。结果:共59例病人纳入研究,PD组37例,DPPHR组22例。两组术前特征无统计学差异。PD组与DPPHR组相比,在术中失血[(332±103)mL比(241±74)mL,P<0.05]、手术时间[(310±91)min比(249±71)min,P<0.05)]和术后住院天数[(14.3±9.0)d比(9.4±8.4)d,P<0.05]上,DPPHR组均优于PD组。两组病人均无术后死亡。两组术后并发症发生率(32.4%比31.8%,P>0.05)和生活质量评分两组无统计学差异,但DPPHR组评分略优于PD组。结论:DPPHR组与PD相比在缓解慢性胰腺炎病人疼痛方面有效。两组生活质量无统计学差异。两组病人在术后并发症发生率和术后死亡率上并无统计学差异,同样安全可行,在术后住院天数、术中失血和手术时间,DPPHR组优于PD组。

Objective To assess the safety and efficiency of duodenum-preserving pancreatic head resection （DPPHR） and pancreaticoduodenectomy （PD） in treatment of chronic pancreatitis. Methods Fifty-nine patients undergoing PD or DPPHR for chronic pancreatitis from Jan 2004 to Dec 2010 were retrospectively reviewed. The preoperative variables, operation data, mortality, morbidity and postoperative hospital stay after the two types of surgery were compared. Quality of life was assessed cross-sectionally using the standard Chinese version of the EORTC QLQ-C30 （version 3.0）. Results Thirty-seven patients underwent PD and 22 underwent DPPHR for the treatment of chronic pancreatitis. The characteristics of patients were similar between the two groups. Estimated blood loss [（332±103） mL vs （241±74） roLl , operation time[（310±91） min vs （249±71） min] and postoperative hospital stay [（14.3 ±9.0） days v s （9.4± 8.4） days] were all less for DPPHR patients （P〈0.05）. There was no postoperative death in either group. Morbidity （32.4% vs 31.8%, P〉0.05） and quality of life scores did not differ between groups. Conclusions DPPHR is as effective as PD in relieving pain and improving quality of life in patients with chronic pancreatitis. Post-operative mortality and morbidity did not differ between two groups. DPPHR resulted in a shorter hospital stay, less blood loss and less operation time.