腹腔镜和开腹胰十二指肠切除术的近期临床疗效对比

Comparison of the short-term clinical efficacies of laparoscopic and open pancreaticoduodenectomy

目的:通过比较腹腔镜胰十二指肠切除术(LPD)和开腹胰十二指肠切除术(OPD)的近期临床疗效,进一步探讨LPD的安全性、可行性。方法:回顾性分析2012年1月~2016年9月在弋矶山医院开展的54例LPD和同期开展的62例OPD患者的临床资料。结果:LPD组(50例,除外中转组4例)与OPD组相比,手术时间延长[(396.40±81.935)min vs.(350.32±99.35)min,P=0.010];术中出血量减少[(282.00±192.396)mL vs.(382.26±248.619)mL,P=0.018];术后下床活动时间较早[(2.44±1.090)d vs.(3.95±1.041)d,P=0.000];肠蠕动恢复时间缩短[(5.28±1.036)d vs.(6.22±1.190)d,P=0.000];术后住院时间显差异无统计学意义[(17.17±6.628)d vs.(18.70±6.892)d,P=0.251];但住院时间≤2周,LPD组多于OPD组(P=0.036);两组在术后并发症发生率方面差异无统计学意义;术后病理提示LPD和OPD组的平均肿瘤大小、清扫的淋巴结数和R0切除率差异无统计学意义。结论:LPD对于经验丰富的外科医生是安全且可行的,相比OPD有一定的微创优势。

Objective:To compare the short term clinical effects of laparoscopic pancreaticoduodenectomy(LPD)and open pancreaticoduodenectomy(OPD)for assessing the safety and reliability of the two approaches.Methods:Retrospective study was performed in54cases treated with LPD and62with OPD in our department between January2012and September2016.Results:Patients in LPD group(n=50,another4cases required conversion to open surgery)had longer operative time[(396.40±81.935)min vs.(350.32±99.35)min,P=0.010],lower intraoperative blood loss[(282.00±192.396)mL vs.(382.26±248.619)mL,P=0.018],early off bed activities[(2.44±1.090)d vs.(3.95±1.041)d,P=0.000]and intestinal function recovery[(5.28±1.036)d vs.(6.22±1.190)d,P=0.000]compared to those in OPD group.Although the postoperative hospital stay was not significantly different between groups[(17.17±6.628)d vs.(18.70±6.892)d,P=0.251],yet LPD group had higher number of patients with hospital stay being less than2weeks(P=0.036).No significant difference was observed in the two groups regarding the incidences of postoperative complications.Postoperative pathology indicated no statistical difference concerning mean tumor size resected,number of lymph nodes clearance and resection margins(R0)between the two procedures.Conclusion:LPD can be safe and feasible in experienced hands,and has less invasion over the OPD.