腹腔镜胰腺假性囊肿内引流术的疗效观察

Clinical effect of laparoscopic internal drainage in treatment of pancreatic pseudocyst

目的对比分析腹腔镜胰腺假性囊肿内引流术(LIDP)与开腹胰腺假性囊肿内引流术(OSIDP)的临床疗效,评价LIDP的可行性、安全性及优越性。方法回顾性分析2011年6月-2016年8月就诊于吉林大学中日联谊医院和吉林大学第二医院行内引流术的46例胰腺假性囊肿(PPC)患者的临床资料,其中22例行LIDP(LIDP组),24例行OSIDP(OSIDP组)。比较并分析2组患者的术前一般情况(性别、年龄、囊肿大小)、术中情况(手术时间、出血量)及术后情况(排气时间、进食时间、术后住院时间、住院费用及并发症)等。符合正态分布且方差齐性的计量资料组间比较采用t检验,方差不齐采用t'检验;计数资料组间比较采用χ~2检验或Fisher精确检验。结果 LIDP组和OSIDP组患者在术中出血量[(87.72±24.48)ml vs(103.75±26.83)ml,t=-2.109,P=0.041]、术后排气时间[(3.00±1.02)d vs(3.79±1.10)d,t=-2.517,P=0.016]、术后首次进食时间[(3.09±0.97)d vs(3.87±0.99)d,t=-2.705,P=0.010]、术后住院天数[(4.90±1.54)d vs(8.66±3.71)d,t=-4.548,P<0.001]和住院费用[(43 402.06±6424.47)元vs(37 668.45±11 249.01)元,t=2.097,P=0.042]方面差异均有统计学意义。LIDP组发生术后并发症2例(9.09%),均为生化漏;OSIDP组术后并发症4例(16.67%),生化漏2例,B级胰瘘2例,其中2例合并出血。结论 LIDP具有创伤小、视野清晰直观、术中出血量少、术后恢复快、住院时间短、并发症发生率低的优势;较OSIDP没有增加手术时间,但平均住院费用较传统开腹内引流术有所增加;该术式简单易行,对手术设备及器械要求不高,具有推广应用价值。

Objective To investigate the clinical effect of laparoscopic internal drainage of pancreatic pseudocyst（ LIDP） versus open surgical internal drainage of pancreatic pseudocyst（ OSIDP） and the feasibility,safety,and superiority of LIDP. Methods A retrospective analysis was performed for the clinical data of 46 patients with pancreatic pseudocyst（ PPC） who underwent internal drainage in China-Japan Union Hospital of Jilin University and The Second Hospital of Jilin University from June 2011 to August 2016,and among these patients,22 underwent LIDP（ LIDP group） and 24 underwent OSIDP（ OSIDP group）. The two groups were compared in terms of preoperative general status（ sex,age,and size of the cyst）,intraoperative conditions（ time of operation and intraoperative blood loss）,and postoperative conditions（ time to first flatus,time to first meal,length of postoperative hospital stay,hospital cost,and complications）. The t-test was used for comparison of normally distributed continuous data with homogeneity of variance between groups,and the t＇test was used for continuous data with heterogeneity of variance; the Pearson chi-square test or the Fisher＇s exact test was used for comparison of categorical data between groups. Results There were significant differences between the two groups in intraoperative blood loss（ 87. 72 ± 24. 48 ml vs 103. 75 ±26. 83 ml,P〈0. 05）,time to first flatus after surgery（ 3. 00 ± 1. 02 d vs 3. 79 ± 1. 10 d,t =-2. 517,P = 0. 016）,time to first meal after surgery（ 3. 09 ± 0. 97 d vs 3. 87 ± 0. 99 d,t =-2. 705,P = 0. 010）,length of postoperative hospital stay（ 4. 90 ± 1. 54 d vs 8. 66 ± 3. 71 d,t =-4. 548,P〈0. 001）,and hospital cost（ 43 402. 06 ± 6424. 47 yuan vs 37 668. 45 ± 11 249. 01 yuan,t = 2. 097,P = 0. 042）. Of all 22 patients in the LIDP group,2（ 9. 09%） experienced the postoperative complication of biochemical leakage; of all 24 patients in the OSIDP group,4（ 16. 67%） experienced postoperative complications（ 2 patients with biochemical leakage and 2 with grade B pancreatic fistula）,among whom 2 patients were complicated by bleeding. Conclusion LIDP has the advantages of small trauma,clear visual field,low intraoperative blood loss,fast postoperative recovery,short length of hospital stay,and low incidence of complications. Compared with OSIDP,LIDP does not increase the time of operation,but it leads to a significant increase in average hospital cost. This surgical procedure is simple and easy and does not have high requirements for surgical equipment,and therefore,it holds promise for clinical application.