腹腔镜与开腹胰十二指肠切除术近期临床疗效评价

Laparoscopic versus open pancreaticoduodenectomy: short-term clinical efficacy evaluation

目的:评价腹腔镜胰十二指肠切除术(LPD)与开腹胰十二指肠切除术(OPD)近期临床疗效。方法:采用回顾性队列研究方法。收集2017年6月至2018年6月我科收治的120例LPD及同期137例OPD病人临床资料,比较两组在围术期的近期临床疗效。结果:全部257例均顺利完成手术。两组一般资料及术前资料差异均无统计学意义(P>0.05)。相比OPD组,LPD组术中出血量少(P<0.001),术后病理切缘阳性率低(P<0.05),LPD组严重并发症(Clavien-Dindo分级≥3)发生率和术后出血、腹腔感染、胃排空障碍发生率低于OPD组(P<0.05),其他相关并发症发生率差异无统计学意义(P>0.05)。术后住院时间及术后镇痛时间,LPD组低于OPD组,两组差异具有统计学意义(P<0.001)。结论:对于熟练掌握LPD并度过学习曲线的团队,LPD围术期近期临床疗效评价与OPD相当,术中出血量、术后并发症发生等较OPD减少。

Objective To evaluate the short-term efficacy of laparoscopic pancreaticoduodenectomy(LPD) and open pancreaticoduodenectomy(OPD). Methods A retrospective cohort study was conducted. The clinical data of 120 patients of LPD group and 137 patients of OPD group in our department from June 2017 to June 2018 were collected to compare perioperative efficacy between 2 groups. Results All 257 patients completed the operation smoothly. There was no significant difference in general and preoperative data between 2 groups(P>0.05). Compared with OPD group, patients in LPD group had less intraoperative blood loss(P<0.001) and less cases with positive margin by postoperative pathology(P<0.05).Postoperative complications including incidence with Clavien-Dindo grading≥3, postoperative hemorrhage, abdominal infection and gastric emptying dysfunction in LPD group were less than those in OPD group(P<0.05). There was no statistical difference in the incidence of other complications(P>0.05). The hospital stay and analgesia time in LPD group during postoperative period were less than those in OPD group with statistical difference(P<0.001). Conclusions LPD would be similar to OPD in short-term clinical efficacy when the team pass operative learning curve and some advantage was found such as less blood loss and less postoperative complications.