不同手术路径在腹腔镜胰十二指肠切除术中钩突切除的对比研究

Comparative study of uncinate process resection in laparoscopic pancreatoduodenectomy with differentsurgical paths

目的:探究不同手术路径在腹腔镜胰十二指肠切除(LPD)术中钩突切除的临床效果。方法:回顾性分析2017年1月至2021年10月接受LPD的80例患者临床资料,所有患者均以肠系膜上动脉(SMA)为中心动脉入路完成手术,根据术中采用不同手术路径分为观察组(n=39例)和对照组(n=41例),观察组采用前方中间联合左后入路,对照组采用常规右侧入路。SPSS 21.0统计学软件完成数据分析,术后并发症等计数资料组间比较行χ^(2)检验;围手术期各项指标等计量资料采用(均数±标准差)表示,组间比较采用t检验;Kaplan-Meier生存曲线分析两组患者预后情况。P<0.05表示差异存在统计学意义。结果:观察组患者手术时间、标本切除时间均长于对照组,术中出血量、淋巴结检出数目及术后住院时间等指标均优于对照组(P<0.05);观察组患者术后并发症总发生率显著低于对照组(P<0.05);两组患者累积无病生存率和累积总生存率比较,差异无统计学意义(Log-Rank χ^(2)=0.874,P=0.350;χ^(2)=0.553,P=0.457)。结论:前方中间入路联合左后入路LPD较传统SMA右侧入路虽延长了手术时间,但对术区淋巴结清扫更彻底,术中多角度暴露术野更利于血管保护,术后并发症更少,更益于患者康复,是一种安全可行的手术入路。

Objective To explore the clinical effect of different surgical paths in laparoscopic pancreatoduodenectomy(LPD).Methods Retrospective analysis was performed on the clinical data of 80 patients who received LPD from January 2017 to October 2021.All patients received the superior mesenteric artery(SMA)as the central artery approach to complete the operation,and were divided into observation group(n=39 cases)and control group(n=41 cases)according to different surgical routes.The observation group received the anteriormiddle approach combined with the left posterior approach.The control group was treated by conventional right approach.SPSS 21.O statistical software was used to complete data analysis,and the count of postoperative complications was compared between the data groups for X test.Measurement data such as perioperative indicators were represented by(mean±standard deviation),and t test was used for comparison between groups.Kaplan-Meier survival curve was used to analyze the prognosis of the two groups.P<0.05 indicated statistically significant differences.Results The operation time and specimen removal time in observation group were longer than those in control group,and the indexes of intraoperative blood loss,number of lymph nodes detected and postoperative hospital stay were better than those in control group(P<0.05).The total incidence of postoperative complications in observation group was significantly lower than that in control group(P<0.05).There was no significant difference in cumulative disease-free survival and cumulative overall survival between the two groups(Log-Rank χ^(2)=0.874,P=0.350;χ^(2)=0.553,P=0.457).Conclusions Compared with the traditional right SMA approach,the anterior middle approach combined with the left posterior approach lengthens the operation time,but it is a safe and feasible surgical approach with more thorough dissection of operative lymph nodes, more beneficial to vascular protection and lesspostoperative complications by exposing the operative field from multiple angles.