胰体尾癌行机器人扩大根治术的临床疗效

Study on clinical effect of robotic extended lymphadenectomy in treatment of cancer of the body and tail of the pancreas

目的:比较达芬奇机器人手术系统行扩大的胰体尾导管腺癌淋巴结清扫术与标准的淋巴结清扫术的临床疗效。方法:回顾性分析我院外科自2010年4月至2015年9月收治54例胰体尾导管腺癌病人的临床资料,其中37例行标准的淋巴结清扫术,17例行扩大的淋巴结清扫术。比较两组病人一般资料、手术时间、术中出血量、术后住院天数、淋巴结清扫数、术后并发症发生率。结果:扩大清扫组与标准清扫组病人一般情况基本一致。扩大清扫组手术时间长于标准清扫组,有统计学差异(231.5 min比141.4 min,P<0.001)。扩大清扫组术后住院天数长于标准清扫组,有统计学差异(22.8 d比20.4 d,P<0.05)。扩大清扫组淋巴结清扫个数多于标准清扫组,有统计学差异(11.2枚比6.1枚,P<0.001)。两组术中出血量、胰漏、胃排空障碍、术后出血、术后感染发生率差异均无统计学意义(P>0.05)。结论:机器人手术系统行胰体尾导管腺癌的淋巴结扩大清扫是安全的,与标准清扫无统计学差异,不增加病人的并发症发生率。

Objective To compare the clinical effect between extended lymphadenectomy with distal pancreatectomy（EL） and standard lymphadenectomy with distal pancreatectomy（SL） in the treatment of pancreatic ductal adenocarcinoma of the body and tail of the pancreas using robotic surgical system. Methods Fifty-four patients with pancreatic ductal adenocarcinoma of the body and tail of the pancreas were analyzed retrospectively from April 2010 to September 2015 including 37 cases in SL group and 17 cases in EL group using robotic surgical system. Patient characteristics, operative time, blood loss, length of postoperative stay, number of lymph node dissection and postoperative complications were compared between EL group and SL group. Results The demographic data of the cases in 2 groups were similar. The operative time in EL group was longer significantly compared with that in SL group（231.5 min vs 141.4 min, P〈0.001）. The patients in EL group had longer length of postoperative stay than in SL group statistically（22.8 d vs 20.4 d, P〈0.05）. The number of lymph node dissection in EL group was more than that in SL group（11.2 vs 6.1, P〈0.001）. There was not significant difference of blood loss, pancreatic leak, delayed gastric emptying, postoperative hemorrhage and postoperative infection between 2 groups（P〉0.05）. Conclusions EL for pancreatic ductal adenocarcinoma of the body and tail of the pancreas using robotic surgical system is safe without any difference when compared with SL and would not increase the rate of complications.