腹腔镜胰十二指肠切除的术式选择及短期疗效分析

Choice of surgical methods and short-term therapeutic efficacy analysis of laparoscopic pancreaticoduodenectomy

目的探讨腹腔镜胰十二指肠切除(LPD)的术式选择及短期临床疗效。方法回顾性分析2015年12月至2017年12月间沧州市中心医院188例行LPD患者的临床资料。胰管直径≥3 mm的102例患者行全腹腔镜胰十二指肠切除(TLPD),采用胰管空肠黏膜端侧吻合重建消化道,为TLPD组;胰管直径<3 mm的86例患者行腹腔镜辅助胰十二指肠切除(LAPD),采用荷包套入式胰肠端侧吻合重建消化道,为LAPD组。分析比较两组各项临床数据。结果两组患者的性别、年龄、ASA分级、术前血总胆红素、谷丙转氨酶及血白蛋白水平差异均无统计学意义,具有可比性。TLPD组患者的切口总长度、术后住院时间显著短于LAPD组[(8.2±1.4)cm比(12.9±2.6)cm,(10.9±5.9)d比(14.3±6.5)d],而胰肠吻合时间显著长于LAPD组[(36.1±14.7)min比(14.0±4.2)min],术后胰瘘发生率显著高于LAPD组(30.4%比10.5%),差异均有统计学意义(P值均<0.05)。两组患者的平均手术时间、术中出血量、淋巴结清扫数目、R0切除率、术后ICU入住时间、术后进流食时间、术后总并发症发生率及术后6个月无瘤生存率的差异均无统计学意义。结论 TLPD具有创伤小、恢复快等优势。但对于胰管直径<3 mm的病例,选择LAPD可增加手术安全性,降低术后胰瘘发生率。

Objective To investigate the choice of surgical methods and short-term therapeutic efficacy of laparoscopic pancreaticoduodenectomy. Methods A retrospective analysis was performed on the clinical data of 188 cases who underwent laparoscopic pancreaticoduodenectomy (LPD) from December 2015 to December 2017 in Cangzhou Central Hospital. Total laparoscopic pancreaticoduodenectomy (TLPD) was performed in 102 patients whose diameter of pancreatic duct was greater than or equal to 3 mm, and end-to-side anastomosis of pancreatic duct and jejunum was used to reconstruct the digestive tract (TLPD group). Laparoscopic assisted pancreaticoduodenectomy (LAPD) was performed in 86 patients with pancreatic duct diameter less than 3 mm, and the digestive tract was reconstructed by end-to-side pancreaticoduodenectomy with pocket-insertion (LAPD group). The clinical data of the two groups were analyzed and compared. Results There were no significant differences on sex, age, ASA grade, preoperative total bilirubin, alanine aminotransferase and serum albumin levels between the two groups(P>0.05), which was comparable. The total incision length and hospitalization time in TLPD group were significantly shorter than those in LAPD group [(8.2±1.4)cm vs (12.9±2.6)cm];[(10.9±5.9)d vs (14.3±6.5)d], while the time of pancreaticojejunostomy was significantly longer than that in LAPD group [(36.1±14.7)min vs (14.0±4.2)min]. The incidence of pancreatic fistula after operation was significantly higher than that in LAPD group (30.4% vs 10.5%). The difference was statistically significant (all P<0.05). There were no significant differences on mean operation time, intraoperative bleeding volume, number of lymph node dissection, R0 resection rate, ICU admission time, eating time, total complication rate and 6-month disease-free survival rate between the two groups. Conclusions TLPD has the advantages of less trauma and quicker recovery. But for pancreatic duct diameter less than 3 mm, the choice of LAPD can increase the safety of operation and reduce the incidence of postoperative pancreatic fistula.