胰体尾肿瘤患者微创与传统手术效果比较

A comparative study between minimally invasive and traditional open surgery in treating patients with pancreatic body or tail lesions

目的探讨微创手术治疗胰体尾病变的可行性和安全性，了解其适应证及优势。方法回顾性分析复旦大学附属华东医院普外科2009年12月至2014年12月因胰腺体尾部肿瘤行胰腺远端切除术的71例患者的临床资料。其中，微创手术远端胰腺切除术共22例（达芬奇机器人远端胰腺切除术15例，腹腔镜胰腺远端切除术7例），开腹胰腺远端切除术49例。统计两组患者一般资料以及手术安全性和术后恢复指标，对相关数据进行对比分析。结果71例胰腺体尾部病变患者同期接受微创胰腺远端切除术（22例）和开腹胰腺远端切除术（49例）。微创组术后患者首次排气时间明显缩短[（2．5±1．0）d比（3．5±1．0）d，P〈0．05]，术后住院时间明显缩短[（15．2±7．9）d比（23．4±21．2）d，P〈0．05]。两组在术后并发胰漏[微创组45．5％（10／22），开腹组55．1％（27／49），P〉0．05]和临床型胰漏风险上[微创组18．2％（4／22），开腹组18．4％（9／49），P〉0．05]差异无统计学意义。微创组手术时间明显长于开腹组[（246．3±75．3）min比（168．1±33．7）min，P〈0．05]。结论微创手术治疗胰腺体尾部肿瘤是安全可行的，术后创伤小、恢复快。机器人手术的应用增加了胰腺胰体尾肿瘤治疗方式的选择。

Objective To study the feasibility, safety, indications and possible advantages of mini- mally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions. Methods From December 2009 to December 2014, the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy （MIDP） or open distal pancreatectomy （ODP） at the General Surgery of Huadong Hospital were retrospectively analyzed. There were 22 patients in the MIDP group and 49 patients in the ODP group. The operations in 15 patients in the MIDP group were per- formed by the Da Vinci robot-assisted surgical system and 7 patients by laparoseopic distal pancreatectomy. Results The MIDP group had a shorter time to pass first flatus [ （ MIDP （ 2. 5± 1.0） d vs ODP （ 3.5 ± 1.0） d, P 〈 0. 05 ], and shorter postoperative hospital stay [ （ MIDP （ 15.2 ±7. 9 ） d vs ODP （23.4 ± 21.2） d, P 〈 0. 05 ] than the ODP group. There were no significant differences on total pancreatic fistula rate [ MIDP 45.5% （10/22） vs ODP 55.1% （27/49）, P 〉 0. 05 ] and symptomatic postoperative pancreatic fistula rate [ MIDP 18.2% （4/22） vs ODP 18.4% （9/49）, P 〉 0. 05 ] between the two groups. The MIDP group had a significant longer operative time [ MIDP （ 246. 3 ±75.3 ） min vs ODP （ 168.1 ± 33.7 ） min, P 〈 0.05 ] than the ODP group. Conclusions Minimally invasive surgery is safe and feasible in treatment of le- sions in pancreatic body or tail with less trauma and faster recovery. The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.