全腹腔镜与开腹胰十二指肠切除术的临床配对研究

A case matched study on laparoscopic versus open pancreaticoduodenectomy

目的探讨全腹腔镜胰十二指肠切除术（TLPD）与开腹胰十二指肠切除术（OPD）的临床治疗效果。方法回顾性分析2013年8月至2015年12月兰州大学第二医院普通外科137例胰十二指肠切除术（PD）患者临床资料。根据手术方式不同，将接受TLPD手术的19例患者纳入实验组，筛选同时期年龄、性别、体重指数、麻醉指数及肿瘤位置匹配的19例OPD手术患者作为对照组。统计分析患者围手术期的各项临床数据，比较两组患者近期临床疗效，总结TLPD手术经验。结果实验组手术时间明显长于对照组[（407．8±146．5）min比（263．3±65．3）min，P〈0．05]；术中出血量[（309．7±151．2）ml比（509．4±309．9）ml]、术后重症监护时间[（47．5±16．8）h比（68．1±19．1）h]、术后恢复排气时间[（3．5±1．1）d比（4．3±1．1）d]、术后住院天数[（8．8±2．1）d比（10．8±2．3）d]及切口长度[（5．1±0．9）cm比（14．4±1．3）cm]等方面较对照组有明显优势（P〈0．05）。实验组与对照组两者术中切缘R0切除率、术中病理结果、肿瘤大小[（20．6±9．6）mm比（25．9±10．2）mm]、淋巴结清扫数目[（17．7±6．5）枚比（19．4±5．6）枚]、并发症发生率、复发率及病死率方面差异无统计学意义（P〉0．05）。结论TLPD不但具有与OPD相同的安全性和根治效果，而且还具有出血少、创伤小、术后恢复快的优势。但是TLPD操作复杂，对器械设备、术者经验及肿瘤位置等均有较高要求。

Objective To compare the clinical outcomes of total laparoscopic pancreatoduodenectomy （TLPD） and open pancreatieoduodenectomy （OPD）. Methods From August 2013 to December 2014, 137 panereaticoduodenectomies （PDs） were performed at the Department of General Surgery of our hospital, of which 19 TLPDs were performed at the Department of Minimally Invasive Surgery （the Experimental group）. At the same time, another cohort of 19 OPDs were matched for age, gender, body mass index （ BMI）, ASA score and tumor site and they formed the control group. The clinical data in the perioperative period were evaluated, and the short-term clinical outcomes were compared. Results Operation time in the experimental group was significantly longer than the control group [ （407.8 ± 146.5 ） min vs （ 263.3 ± 65.3 ） min, P 〈 0.05 ]. The mean intraoperative blood loss [ （ 309.7 ± 151.2） ml vs （509.4 ± 309.9） ml ] , mean intensive care time after surgery [ （47.5 ±16.8 ）h vs （68.1 ± 19.1 ）h ] , mean postoperative time to pass flatus [ （ 3.5± 1.1 ） d vs （4.3± 1.1 ） d ], mean postoperative hospitalization stay [ （ 8.8 ± 2.1 ） d vs （ 10.8 ± 2.3 ） d ] and mean incision length [ （ 5.1 ± 0.9 ） cm vs （ 14.4 ± 1.3 ） cm ] in the experimental group were significantly different from the control group （ P 〈 0.05 ）. There were no significant differences on the intraoperative R0 resection rates, intraoperative pathology, tumor size [ （ 20.6 ±9.6 ） mm vs （ 25.9 ± 10.2 ） mm ], number of lymph node dissected [ （ 17.7 ±6.5 ） vs （ 19.4 ± 5.6） ], complication rates, recurrence rates and mortality between the two groups （ P 〉 0. 05 ）. Conclusions TLPD had comparable safety and therapeutic outcome when compared with OPD. Moreover, TLPD has the advantages of less bleeding, smaller wounds and faster postoperative recovery. TLPD requires specialized appliances and equipments, better surgeon experience and patient selection to achieve a high success rate.