机器人与开腹胰十二指肠切除术治疗壶腹周围癌的近期疗效对比分析

Comparative analysis of short-term efficacy of robotic versus open pancreaticoduodenectomy for periampullary carcinoma

目的:对比分析机器人胰十二指肠切除术(RPD)与开腹胰十二指肠切除术(OPD)治疗壶腹部周围癌的近期疗效。方法:2015年1月至2018年12月行胰十二指肠切除术的63例患者,根据手术方式分为RPD组(n=28)与OPD组(n=35),评估RPD与OPD的手术效果。结果:RPD组手术时间[403(337,474)min vs.299(189,425)min,P=0.001]长于OPD组,但术中出血量[164.29(50,200)mL vs.355.14(100,500)mL,P=0.001]、输血率(25%vs.77.1%,P<0.001)、住院时间[(13.96±2.71)d vs.(18.20±8.72)d,P=0.016)]优于OPD组;两组胰瘘、胆漏、胃排空延迟、腹腔感染等并发症发生率差异无统计学意义(P>0.05),术后腹腔引流管拔除时间、再次手术率、病死率两组差异亦无统计学意义(P>0.05)。结论:与OPD相比,RPD术后住院时间短,术中出血量、输血率更低,但手术时间更长,两种术式并发症发生率相当,RPD是安全、可行的,可能具有更大的发展潜力。

Objective:To compare and analyze the short-term effect of robotic pancreaticoduodenectomy(RPD)with open pancreaticoduodenectomy(OPD)for periampullary cancer.Methods:From Jan.2015 to Dec.2018,63 cases of pancreaticoduodenectomy were enrolled into the study and were divided into RPD group(n=28)and OPD group(n=35).The situation of surgery,complications and postoperative recovery in two groups was evaluated.Results:The operation time of the RPD group was significantly longer than that in the OPD group[403(337,474)min vs.299(189,425)min],whereas the intraoperative blood loss[164.29(50,200)mL vs.355.14(100,500)mL],the transfusion rate(25%vs.77.1%)and mean hospital stay[(13.96±2.71)d vs.18.20±8.72)d]in the RPD were significantly lower than those in the OPD group(P<0.05).The incidence of pancreatic fistula,biliary leakage,delayed gastric emptying and abdominal infection were not significant different(P>0.05).There was no significant difference in the time of abdominal drainage tube removal,reoperation or mortality(P>0.05).Conclusions:The hospitalization time after RPD is shorter,the intraoperative blood loss and blood transfusion rate are lower,but the operation time is longer than OPD.The RPD is equivalent to OPD in the incidence of complications,which confirms the safety and feasibility of RPD,there may be greater development potential in the future.