腹腔镜与开腹胰十二指肠切除术的疗效对比研究

Comparative effectiveness research of laparoscopic and open pancreaticoduodenectomy

目的:探讨腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效。方法:回顾分析2017年6月至2021年6月收治的94例胰头癌患者的临床资料。根据手术方法将患者分为对照组(n=43,行开腹胰十二指肠切除术)与观察组(n=51,行腹腔镜胰十二指肠切除术)。比较两组手术相关指标、术后并发症发生率及术前、术后第3天的炎症因子水平。结果:两组手术时间、失血量、输血率、切缘阳性率、淋巴结清扫数量、淋巴结阳性率差异均无统计学意义(P>0.05)。观察组术后排气时间[(3.20±1.04)d vs.(4.32±1.35)d]、术后下床活动时间[(2.75±1.08)d vs.(4.50±1.12)d]、住院时间[(8.25±2.01)d vs.(11.42±3.27)d]短于对照组(P<0.05)。两组术后并发症发生率差异无统计学意义(P>0.05)。术后第3天,观察组前列腺素E2[(211.05±23.22)pg/mL vs.(327.65±39.32)pg/mL]、5-羟色胺[(95.64±11.48)mg/L vs.(127.35±19.10)mg/L]低于对照组(P<0.05)。结论:腹腔镜胰十二指肠切除术治疗胰头癌的安全性、效果较好,与开腹手术相比,腹腔镜手术对术后疼痛因子的影响较小,临床应根据患者情况选择恰当的方案。

Objective:To explore the effectiveness of laparoscopic pancreaticoduodenectomy(LPD)and open pancreaticoduo-denectomy(OPD)in the treatment of pancreatic head cancer.Methods:A retrospective analysis was conducted on the clinical data of 94 patients with pancreatic head cancer treated between Jun.2017 and Jun.2021.According to different surgical methods,the patients were divided into control group(n=43,OPD)and observation group(n=51,LPD).Surgical-related indicators,postoperative compli-cation rates,and inflammatory factor level before surgery and on the 3rd day after surgery were compared between the two groups.Results:There were no statistically significant differences in surgical time,blood loss,transfusion rate,positive margin rate,number of lymph node harvested,and positive lymph node rate between the observation group and the control group(P>0.05).However,the ob-servation group had significantly shorter postoperative flatus time[(3.20±1.04)d vs.(4.32±1.35)d],postoperative ambulation time[(2.75±1.08)d vs.(4.50±1.12)d],and hospital stay[(8.25±2.01)d vs.(11.42±3.27)d]compared with the control group(P<0.05).There was no statistically significant difference in postoperative complication rates between the two groups(P>0.05).Further-more,on the third day after surgery,the levels of prostaglandin E2[(211.05±23.22)pg/mL vs.(327.65±39.32)pg/mL]and 5-hydroxytryptamine[(95.64±11.48)mg/L vs.(127.35±19.10)mg/L]in the observation group were significantly lower than those in the control group(P<0.05).Conclusions:LPD shows better safety and effectiveness in patients with pancreatic head cancer.Compared with open surgery,laparoscopic surgery has a smaller impact on postoperative pain factors,the most appropriate choice should be made based on specific circumstances in practical work.