腹腔镜胰十二指肠切除术对胰头癌术后并发症及预后的影响分析

Analysis of postoperative complications and prognosis of patients with pancreatic head cancer treated by laparoscopic pancreaticoduodenectomy

目的比较腹腔镜胰十二指肠切除术与传统开腹胰十二指肠切除术治疗胰头癌的效果、预后及并发症发生情况。方法回顾性分析本院2010年1月至2013年6月收治的66例中晚期胰头癌患者的临床资料,其中29例患者行腹腔镜辅助胰十二指肠切除术(观察组),37例患者行传统开腹胰十二指肠切除术(对照组)。观察两组患者术中和术后相关指标,术后并发症发生率及远期生存的差异。结果观察组患者手术时间长于对照组(P<0.05),住院费用高于对照组(P<0.05),术中出血量和术后采取药物止痛次数少于对照组(P<0.05),术后肛门排气时间、引流管拔除时间、进食流质食物时间及住院天数均短于对照组(P<0.05)。两组患者总并发症发生率比较无显著差异(P>0.05),各单一并发症发生率组间比较均具有显著差异(P<0.05)。两组患者预后比较均无显著差异(P>0.05),观察组患者术后3年生存率显著低于对照组(P<0.05)。结论腹腔镜胰十二指肠切除术能缩短胰头癌患者术后恢复时间,降低胃排空延迟、切口感染、腹腔感染感染及肠梗阻等术后并发症发生率。

Objective To compare the efficacy, prognosis and complications of laparoscopic pancreati-coduodenectomy （LPD） and traditional open pancreaticoduodenectomy （OPD） for the treatment of pancreatic head cancer. Method Clinical data of 66 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from January 2010 to June 2013 were collected, of which 29 patients were enrolled in LPD group and 37 patients were enrolled in OPD group. Observed the two groups of patients with intraoperative and postoperative related indicators, postoperative complications and long-term survival differences. Result The operation time of observation group was longer than that of control group （P 〈 0.05）, hospitalization expense was higher than that of control group （P 〈 0.05）, the amount of bleeding and postoperative analgesic drug taken in times less than that of control group （P 〈 0.05）, anal exhaust time, postoperative extubation time, eating time and hospitalization time of liquid food were shorter than control group （P 〈 0.05）. There was no significant difference in the incidence of total complication between the two groups （P 〉 0.05）. There was significant difference in the incidence of single complication between the two groups （P 〈 0.05）. There was no significant difference in the prognosis between the two groups （P 〉 0.05）. The survival rate of the observation group was significantly lower than that of control group （P 〈 0.05）. Conclusion In the case of pancreatic head cancer, laparoscopic pancreaticoduodenectomy can shorten the recovery time of patients, reduce the incidence of postoperative complications such as delayed gastric emptying, incision infection, intra-abdominal infection and intestinal obstruction.