机器人辅助与腹腔镜胰十二指肠切除术治疗壶腹周围癌的临床对比研究

Clinical comparison study on robot-assisted and laparoscopic pancreaticoduodenectomy for periampullary carcinoma

目的:对比分析机器人辅助胰十二指肠切除术(Robot-assisted Pancreaticoduodenectomy,RPD)与腹腔镜胰十二指肠切除术(Laparoscopic Pancreaticoduodenectomy,LPD)治疗壶腹周围癌的临床应用情况,并总结RPD的经验。方法:回顾性分析2018年10月—2021年8月于华中科技大学同济医学院附属协和医院肝胆外科行RPD和LPD手术的93例患者的临床资料。其中行RPD者52例,设为RPD组;行LPD者41例,设为LPD组。分析两组患者手术时间、术中出血量、术后住院时间、住院费用、并发症等情况。结果:RPD组所有患者均顺利完成机器人辅助胰十二指肠切除术,无中转开腹或中转腹腔镜患者。RPD组和LPD组平均手术时间分别为(322.7±94.6)min和(351±102.3)min,平均术中出血量分别为(230.5±178.3)ml和(302.5±108.6)ml,接受术中输血者分别为3例和5例,术后首次进食时间分别为(4.3±1.6)d和(5.7±2.5)d,术后首次肛门排气时间分别为(2.5±1.8)d和(3.3±2.1)d,住院时间分别为(12.3±4.6)d和(14.6±5.2)d,住院费用分别为(14.8±5.1)万元和(11.6±3.5)万元,消化道重建时间分别为(91.2±25.3)min和(112.6±42.5)min。RPD组住院费用高于LPD组,消化道重建时间少于LPD组,组间差异有统计学意义(P<0.05)。RPD组术后发生胰瘘者2例,胆瘘者1例,腹腔内出血者1例,胃排空延迟者1例;LPD组术后发生胰瘘者3例,胆瘘者2例,腹腔内出血者1例,胃排空延迟者1例。RPD组胰瘘发生率、胆瘘发生率低于LPD组,差异有统计学意义(P<0.05)。结论:RPD较LPD在临床中应用效果好,术后胰瘘、胆瘘发生率更低,具有一定的临床优势。

Objective:To compare the clinical efficacy of robot-assisted pancreaticoduodenectomy(RPD)and laparoscopic pancreaticoduodenectomy(LPD)in treating periampullary carcinoma and summarize the clinical experience of RPD.Methods:The clinical data of 93 patients who underwent RPD and LPD in the Department of Hepatobiliary Surgery,Union Hospital,Tongji Medical College of Huazhong University of Science and Technology from October 2018 to August 2021 were retrospectively analyzed.Among them,52 patients underwent RPD were divided into the RPD group,and 41 patients underwent LPD into the LPD group.The operative time,intraoperative blood loss,postoperative length of stay,hospitalization cost,complications and other conditions of patients in the two groups were compared and analyzed.Results:All surgeries in the RPD group were successfully completed,and no conversion to laparotomy or laparoscopic surgery.The mean operative time of RPD group and LPD group were(322.7±94.6)min and(351±102.3)min respectively,with the mean intraoperative blood loss of(230.5±178.3)ml and(302.5±108.6)ml respectively.3 patients in the RPD group and 5 patients in the LPD group received intraoperative blood transfusion.The first postoperative feeding time of the RPD group and LPD group were(4.3±1.6)d and(5.7±2.5)d respectively,with the first postoperative anal exhaust time of(2.5±1.8)d and(3.3±2.1)d respectively.The length of stay of the RPD group and LPD group were(12.3±4.6)d and(14.6±5.2)d respectively,with the hospitalization cost of(148.0±51.0)thousand CNY and(116.0±35.0)thousand CNY respectively.The reconstruction time of digestive tract of the RPD group and LPD group were(91.2±25.3)min and(112.6±42.5)min respectively.The hospitalization cost of the RPD group was higher than that of the LPD group,and the reconstruction time of digestive tract was shorter than that of the LPD group(P<0.05).In the RPD group,there were 2 cases of pancreatic fistula,1 case of biliary fistula,1 case of intraperitoneal bleeding,and 1 case of delayed gastric emptying.In the LPD group,3 cases of pancreatic fistula,2 cases of biliary fistula,1 case of intraperitoneal bleeding,and 1 case of delayed gastric emptying occured after surgery.The incidence of pancreatic fistula and biliary fistula in the RPD group was lower than that in the LPD group,and the difference was statistically significant.Conclusion:The clinical outcomes of RPD is good,and the incidence of postoperative pancreatic fistula and biliary fistula is lower than that of the LPD,which has certain clinical advantages.