同期腹腔镜与开放胰十二指肠切除术的临床疗效比较

Comparison of clinical efficacy between laparoscopic and open pancreaticoduodenectomy

目的 比较同期腹腔镜与开放胰十二指肠切除术的临床疗效。方法 2017年7月至2022年3月我院行胰十二指肠切除术患者82例,按手术路径不同分为腹腔镜胰十二指肠切除术组(LPD组)40例与开放胰十二指肠切除术组(OPD组)42例,比较两组患者的围手术期指标。结果 LPD组施行创新的“双荷包-支架法”胰肠吻合术,OPD组采用胰管-空肠黏膜胰肠吻合术,两组患者均顺利完成手术。LPD组术中出血量、术后住院天数、首次肛门排气时间、首次进食时间少于OPD组,差异有统计学意义(P<0.05);两组术后总并发症发生率和Ⅲa级以上并发症发生率比较,差异均无统计学意义(P>0.05)。结论 在做到手术规范性和掌握并改进腹腔镜胰肠吻合等关键技术条件下,把握好手术适应证,开展腹腔镜胰十二指肠切除术安全可行,在术后恢复方面相较于开放手术有一定优势。

Objective To compare the clinical curative effect between laparoscopic and open of pancreaticoduodenal resection.Methods Between July 2017 and March 2022, 82 patients undergoing pancreaticoduodenal resection in our hospital were selected. According to operation method, they were divided into a laparoscopic pancreaticoduodenal resection group(LPD group, n=40) and an open pancreaticoduodenal resection group(OPD group, n=42). Perioperative indexes were compared between the two groups.Results The LPD group underwent the innovative "double purse-stent method" pancreaticojejunostomy, while the OPD group underwent pancreatic duct-jejunostomy-mucosal pancreaticojejunostomy. Both groups successfully completed the operation. The intraoperative blood loss, postoperative hospital stay, anal exhaust time, and the first meal time in the LPD group were less or shorter than those in the OPD group(P<0.05). There was no significant difference in the total rate of postoperative complications and the incidence of postoperative complications with IIIa level or above(P>0.05).Conclusion It is safe and feasible to carry out laparoscopic pancreaticoduodenectomy under the conditions of standardization of surgery and mastery and improvement of key techniques. It has certain advantages in terms of postoperative recovery when compared to open surgery.