腹腔镜胰十二指肠切除术联合加速康复外科的安全性和有效性探讨

Discussion on Safety and Effectiveness of Laparoscopic Pancreaticoduodenectomy combined with Accelerated Rehabilitation Surgery

目的:探讨腹腔镜胰十二指肠切除术联合加速康复外科的安全性和有效性。方法:选择2015年5月至2018年3月医院收治的接受胰十二指肠切除术患者84例,根据手术方式进行分组,对照组42例行开腹胰十二指肠切除术,观察组42例行腹腔镜胰十二指肠切除术。比较两组治疗的安全性与有效性。结果:观察组手术时间(543.8±59.2)min,高于对照组;观察组术中出血量(191.5±56.2)mL,术中需要输血患者比例30.00%,均低于对照组(P<0.05)。观察组术后2h、6h及12h的VAS评分均低于对照组(P<0.05)。观察组胃排空延迟比例6.0%,低于对照组26.0%(P<0.05);观察组重症监护室入住时间(2.4±0.8)d,住院时间(14.6±1.3)d,均短于对照组(P<0.05)。观察组手术后阳性淋巴结数(1.0±0.4)个,血管浸润比例8.0%,肿瘤直径(2.7±0.6)cm,中/中-低分化肿瘤比例42.0%,均低于对照组(P<0.05)。结论:腹腔镜胰十二指肠切除术联合加速康复外科安全有效,值得推广。

Objective: To investigate the safety and efficacy of laparoscopic pancreaticoduodenectomy combined with accelerated rehabilitation surgery. Methods: 84 patients undergoing pancreaticoduodenectomy admitted to the hospital were enrolled according to the surgical procedure. 42 patients in the control group underwent open pancreaticoduodenectomy. 42 cases underwent laparoscopic pancreaticoduodenectomy. The safety and efficacy of the two groups of treatments were compared. Results: The operation time of the observation group was (543.8±59.2) min, which was higher than that of the control group. The intraoperative blood loss (191.5±56.2) mL in the observation group was 30.00% in the transfusion patients, which was lower than the control group (P<0.05). The VAS scores of the observation group at 2h, 6h and 12h after operation were lower than those of the control group (P<0.05). The delay of gastric emptying in the observation group was 6.0%, which was lower than that of the control group (26.0%)(P<0.05). The intensive care unit (2.4±0.8) days and the hospitalization time (14.6±1.3) days were shorter than the control group (P<0.05). The number of positive lymph nodes in the observation group was 1.0±0.4, the ratio of vascular invasion was 8.0%, the diameter of tumor was (2.7±0.6) cm, and the proportion of middle/middle-lower differentiated tumor was 42.0%, which was lower than that of the control group (P<0.05). Conclusion: Laparoscopic pancreaticoduodenectomy combined with accelerated rehabilitation surgery is safe and effective, which is worthy of promotion.