腹腔镜胰十二指肠切除术治疗早期胰头癌患者的效果

Effects of laparoscopic pancreaticoduodenectomy in treatment of patients with early pancreatic head cancer

目的:观察腹腔镜胰十二指肠切除术(LPD)治疗早期胰头癌患者的效果。方法:选取2022年8月至2023年10月该院收治的92例早期胰头癌患者进行前瞻性研究,按照随机数字表法将其分为对照组与观察组各46例。对照组采用开腹胰十二指肠切除术(OPD)治疗,观察组采用LPD治疗。比较两组围术期相关指标(手术时间、术中出血量、淋巴结清扫数目、术后排气时间、下床时间、住院时间及术后疼痛程度)水平、手术前后T细胞亚群指标(CD4+、CD8+、CD4+/CD8+)水平、R0切除率、半年复发率及并发症发生率。结果:两组淋巴结清扫数目比较,差异无统计学意义(P>0.05);观察组术中出血量少于对照组,手术时间长于对照组,术后排气时间、下床时间及住院时间短于对照组,视觉模拟评分法评分低于对照组,差异均有统计学意义(P<0.05);术后,两组CD4+、CD4+/CD8+水平均低于术前,但观察组高于对照组,两组CD8+水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);两组R0切除率、半年复发率、并发症发生率比较,差异均无统计学意义(P>0.05)。结论:与传统OPD相比,LPD治疗早期胰头癌患者可减少术中出血量,缩短术后排气时间、下床时间及住院时间,减轻术后疼痛程度,且术中淋巴结清扫数目、R0切除率、半年复发率、并发症发生率与OPD相当,但会延长手术时间。

Objective:To observe effects of laparoscopic pancreaticoduodenectomy(LPD)in treatment of patients with early pancreatic head cancer.Methods:A prospective study was conducted on 92 patients with early pancreatic head cancer admitted to this hospital from August 2022 to October 2023.According to the random number table method,they were divided into control group and observation group,46 cases in each group.The control group was treated with open pancreaticoduodenectomy(OPD),while the observation group was treated with LPD.The perioperative related indexes(operation time,intraoperative blood loss,number of lymph node dissection,postoperative exhaust time,ambulation time,hospitalization time and postoperative pain degree)levels,the T cell subpopulation indexes(CD4+,CD8+,CD4+/CD8+)levels before and after the surgery,the R0 resection rate,the half-year recurrence rate,and the incidence of complications were compared between the two groups.Results:There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group,the operation time was longer than that in the control group,the postoperative exhaust time,the ambulation time and the hospitalization time were shorter than those in the control group,the visual analogue scale score was lower than that in the control group,and the differences were statistically significant(P<0.05).After the surgery,the levels of CD4+and CD4+/CD8+in the two groups were lower than those before the surgery,but those in the observation group were higher than those in the control group;the levels of CD8+in the two groups were higher than those before the surgery,but that in the observation group was lower than that in the control group;and the differences were statistically significant(P<0.05).There were no significant differences in the R0 resection rate,the half-year recurrence rate and the incidence of complications between the two groups(P>0.05).Conclusions:Compared with traditional OPD,LPD in the treatment of the patients with early pancreatic head cancer can reduce the intraoperative blood loss,shorten the postoperative exhaust time,ambulation time,hospitalization time and reduce the postoperative pain.The number of lymph node dissection,the R0 resection rate,the half-year recurrence rate,and the incidence of complications are comparable to those of OPD,but it may prolong the operation time.