腹腔镜与开腹手术影响胰十二指肠切除术后胃排空延迟的对比研究

Delayed gastric emptying after laparoscopic versus open pancreaticoduodenectomy： a comparativestudy

目的比较腹腔镜与开腹手术对胰十二指肠切除术后胃排空延迟的影响。方法回顾性分析2010年10月至2012年10月完成的67例胰十二指肠切除术患者的围手术期临床资料，其中腹腔镜组20例，开腹组47例（保留幽门的胰十二指肠切除术22例，标准胰十二指肠切除术25例）。比较腹腔镜与开腹手术对胃排空延迟、围手术期的并发症和住院时间的影响，探讨胰十二指肠切除术后发生胃排空延迟的危险因素。结果腹腔镜组手术时间长于开腹组[（494±46）rain比（391±70）min，t=-4．40，P=0．00）]，但术中出血量更少[（294±158）ml比（399±68）ml，t=2．73，P=0．008]，术后住院时间更短（13．0d比16．3d，t=3．01，P=0．009）。腹腔镜组与开腹组术后胃排空延迟和并发症的发生率无明显差异。腹腔镜组术后30d无死亡，开腹组死亡1例。多因素Logistic回归分析显示手术时间较长（OR=1．01，95％CI：1．000-1．024，P=0．048）、术中出血量过多（OR=1．01，95％CI：1．000～1．022，P=0．040）及术后腹部并发症（OR=6．22，95％CI：1．400-27．700，P=0．017）是术后发生胃排空延迟的危险因素。胃排空延迟患者术后住院时间更长（19．7d比13．6d，t=-6．50，P=0．000）。结论手术时间较长、术中出血量较多及术后腹部并发症可能是胃排空延迟发生的危险因素，与开腹手术相比腹腔镜腹胰十二指肠切除术是安全可行的。

Objective To investigate the effect on postoperative delayed gastric emptying （DGE） after laparoscopic versus open pancreaticoduodenectomy （PD）. Methods Data from 67 consecutive PD procedures performed between October 2010 and October 2012 were retrospectively analyzed. Among them, 20 patients underwent laparoscopic PD （ LPD group）, and 47 patients underwent open PD （ OPD group ; 22 patients underwent pylorus-preserving PD, 25 patients underwent standard PD ）. Results The LPD group had significantly longer operative times （ （494 ± 46 ） minutes vs. （ 391 ±70 ） minutes, t = - 4. 40, P = 0. 000） , reduced blood loss （ （294 ± 158） ml. vs. （399±68 ） ml, t = 2. 73, P = 0. 008 ） and shorter postoperative hospital stay （ 13.0 days vs. 16. 3 days, t = 3.01, P = 0. 009） compared to the OPD group. However, there was no difference in terms of DGE occurrence and postoperative complication rates. There was one postoperative death in the OPD group and none in the LPD group. Multivariate analysis by Logistic regression showed that DGE was significantly more frequent among patients with longer operative times （ OR = 1.01,95% CI： 1. 000-1. 024, P = 0. 048 ） , increased intraoperative blood loss （ OR = 1.01, 95% CI： 1. 000-1. 022, P =0. 040） and postoperative intraabdominal complications （ OR = 6. 22, 95% CI： 1. 400- 27. 700, P = 0. 017 ）. Mean postoperative hospital stay was longer among patients who developed DGE （ 19. 7 days vs. 13.6 days, t = - 6. 50, P = 0. 000 ） than those without DGE. Conclusions Longer operative time, increased intraoperative blood loss and postoperative intraabdominal complications appear to be risk factors for DGE development. Meanwhile, the laparoscopic approach PD is safe and feasible, and outcomes appears comparable with those undergoing an open approach.