动脉优先入路技术在高难度胰十二指肠切除术中的应用

Application of artery priority approach in pancreatoduodenectomy

目的探讨动脉优先入路技术在高难度胰十二指肠切除术中的应用效果。方法选取2018年1月至2021年9月在皖南医学院附属池州医院肝胆外科接受胰十二指肠切除术的49例患者,依据手术方式的不同分为观察组(26例)和对照组(23例)。观察组采用行动脉优先入路胰十二指肠切除术治疗,对照组采用传统的胰十二指肠切除术治疗。比较两组患者的围术期一般指标,血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)及CA125等肿瘤标记物水平,生活自理能力评分,治疗效果及并发症发生情况,并采用Kaplan-Meier生存曲线比较两组患者的生存时间。结果观察组患者手术时间、消化道重建时间、术中出血量、住院时间均明显低于对照组(P<0.05)。术前两组血清CEA、CA19-9、CA125水平比较差异无显著性(P>0.05);术后两组血清CEA、CA19-9、CA125水平均明显低于术前,且观察组明显低于对照组(P<0.05)。术前两组生活自理能力评分比较差异无显著性(P>0.05);术后两组生活自理能力评分均明显高于术前,且观察组明显高于对照组(P<0.05)。观察组的治疗有效率及无进展生存率明显高于对照组,并发症发生率明显低于对照组,差异均有显著性(P<0.05)。Kaplan-Meier生存曲线分析显示,观察组的生存时间明显优于对照组(P<0.05)。结论相较于传统入路方法,在高难度胰十二指肠切除术中积极选用动脉优先入路技术可取得较好的临床效果,具有安全、高效、创伤小等优势,进而可改善远期预后,提高患者的生活质量。

Objective To select patients who accept arterial priority approach technology and compare it with the traditional surgical approach,to find a better approach in difficult pancreaticoduodenectomy and provide scientific and reasonable guidance for clinic.Method The subjects were all patients who underwent pancreaticoduodenectomy from January 2018 to September 2021;They were divided into two groups according to the results of doctor-patient communication.In the study group,26 patients underwent pancreatoduodenectomy through active pulse first approach;23 patients in the control group received conventional radical resection of pancreatic cancer.The observation indexes include:Comparison of general indexes in perioperative period between the two groups;Comparison of postoperative complications between the two groups;Comparison of tumor markers between the two groups before and after operation:cancer antigen 19-9(CA19-9),cancer antigen 125(CA125)and carcinoembryonic antigen(CEA);Comparison of self-care ability scores between the two groups before and after operation;Comparison of the treatment effect between the two groups after operation:excellent,good,general and poor;Analysis of the survival status of the two groups after operation.Result The operation time,gastrointestinal reconstruction time,intraoperative bleeding,hospital stay and the total incidence of complications in the study group were significantly lower than those in the control group(P<0.05);CA19-9,CA125 and CEA in the study group were significantly lower than those in the control group before and after operation(P<0.05);The score of self-care ability in the study group was significantly higher than that in the control group(P<0.05);The effective rate and no progress rate of the study group were significantly higher than those of the control group(P<0.05);The survival status of the two groups showed that the survival time of the study group was significantly longer than that of the control group(P<0.05).Conclusion Compared with the traditional approach,the active selection of arterial priority approach in the cleaning of difficult pancreaticoduodenectomy can achieve better clinical application effect,with the advantages of safety,efficiency and less trauma.It can effectively improve the clinical efficacy of pancreaticoduodenectomy,and then improve the long-term prognosis and quality of life.