胰十二指肠切除术118例单中心临床经验

Pancreaticoduodenectomy： a single center experience of 118 patients

目的总结单中心单组3年来胰十二指肠切除术（PD）患者的病历资料和诊疗经验。方法回顾性分析天津医科大学肿瘤医院胰腺科同一手术组2015年1月至2017年12月施行的118例PD患者病历资料。结果118例PD术包括开腹胰十二指肠切除术（OPD）102例，腹腔镜胰十二指肠切除术（LPD）16例。男性64例，女性54例，年龄13．0～78．0（56．0±12．0）岁。其中，恶性肿瘤占73．7％（87／118）。手术时间（324．0±95．6）min；术中出血量（192．8±97．5）ml；住院时间（19．9＋9．5）d；R0切除率100％。患者术后并发症发生率为46．6％（55／118），围手术期病死率为0。LPD比OPD手术时间略有延长，但在术中出血、术后住院时间、淋巴结清除及并发症发生率方面差异均无统计学意义（均P〉0．05）。结论胰十二指肠切除术安全可行，术后并发症发生率虽高，但患者通过积极治疗后均顺利出院。LPD较OPD虽未显示出明显优势，但其应用前景值得肯定。

Objective To study the clinical experience on pancreaticoduodenectomy （PD） in the past three years from a single operation group at the Cancer Institute and Hospital of Tianjin Medical Univer- sly. Methods The clinical data of 118 patients who underwent PD from January 2015 to December 2017 were collected and analyzed retrospectively. Results Of the 118 patients who underwent PDs, 102 under- went open pancreaticoduodenectomy （OPD） （86. 4%）, and 16 laparoscopic pancreaticoduodenectomy （LPD） （13.6%）. There were 54. 2% males with a age of （56. 0±12.0） years （39. 83% over 60 years）. Malignancy was confirmed by pathology in 73.7% （87/118 patients）. The operative time was （324.0±95.6） minutes. Intraoperative blood loss was （192. 8±97.5） ml and R0 resection was achieved in all patients. The postoperative complication rate was 46.6% （55/118）. The median postoperative hospital stay was （ 19. 9±9. 5） days. There was no perioperative mortality. The operation time of LPD was significantly longer than OPD, but there was no significant difference in intraoperative bleeding, lymph node clearance, postop- erative complication rate and postoperative hospital stay （P〉0. 05）. Conclusions PD is safe and feasible. The postoperative complication rate was relatively high but all patients were discharged from hospital after ap- propriate treatment. Compared with OPD, LPD is a better alternative for patients.