腹腔镜胰十二指肠切除术的安全性和有效性研究

An exploration of the security and effectiveness of laparoscopic pancreaticoduodenectomy

目的探讨腹腔镜胰十二指肠切除术（LPD）的安全性和有效性。方法回顾性分析2014年5—12月于华中科技大学同济医学院附属同济医院胆胰外科完成的60例胰十二指肠切除术患者的围术期临床资料，其中LPD30例，开腹胰十二指肠切除术（OPD）组30例。比较两组患者围术期结果间的差异。结果LPD组患者手术时间长于OPD组[（542．6±58．6）minw（383．1±64．6）min，P〈0．001）]，但术中出血量更少[（190．3±192．0）mlvs（373．3±363．8）ml，P=0．018）]，术中输血率更低（30％w66．7％，P=0．004），术后胃排空延迟发生率更低（6．7％vs26．7％，P=0．038），入住科室ICU时间[（2．3±0．9）dvs（5．0±0．9）d，P〈0．001）]及住院时间[（14．7±1．2）dUS（18．5±2．1）d，P〈0．001）]更短，肿瘤直径更小[（2．6±0．7）cmvs（3．9±2．4）cm，P=0．009）]。两组患者术后胰瘘、胆瘘、出血、腹腔感染／脓肿、切口感染、二次手术率、总并发症发生率、病死率、手术切缘（R0切除率）、术中切除淋巴结数、阳性淋巴结数、血管浸润率及肿瘤分化程度间比较，差异均无统计学意义。结论LPD虽手术复杂、难度大，然对经验丰富的胰腺外科医师而言，该术式是安全有效的。

Objective To explore the security and effectiveness of laparoscopic pancreaticoduodenectomy （ LPD ）. Methods Perioperative clinical data of 60 consecutive panereaticoduodenectomy （PD） procedures performed from May 2014 to Dec. 2014 in Biliary and Pancreatic Surgical Central of Tong Ji Hospital, Tong Ji Medical College were retrospective analyzed, among which 30 patients underwent LPD （ LPD group） while 30 patients received open pancreaticoduodenectomy （ OPD group）. Perioperative outcomes were compared within the two groups. Results The LPD group had significantly longer operative time [ （ 542.6 ± 58.6 ） rain vs （ 383.1 ±64.6 ） rain, P 〈 0. 001 ], reduced estimated blood loss [ （ 190.3±192.0） ml vs （ 373.3 ± 363.8 ） ml, P = 0. 018 ] , less transfusion rate （30% vs 66. 7 % , P = 0. 004 ） , less delayed gastric emptying ratio （6.7% vs 26. 7 % , P = 0. 038 ） and shorter length of hospital stay and intensive care unit stay [ （ 14.7 ± 1.2） d vs （ 8.5± 2.1 ） d, P 〈 0. 001 ] and [（2.3 ±0.9） dvs （5.0±0.9） d, P〈0. 001] respectively, compared to OPD group. The LPD had smaller tumor sizes [（2.6±0.7） em vs （3.9±2.4） cm, P =0.009]. There were no significant differences between the two groups in pancreatic fistula, biliary leakage, postoperative hemorrhage, abdominal infection/abscess, wound infection, reoperation rate, overall morbidity rate, mortality, R0 ratio, the number of harvested lymph node, the number of positive lymph node, vascular invasive rate and tumor differentiation degree. Conclusion LPD, though complicated and difficult, serve as a safe and effective method for experienced surgeons.