腹腔镜胰十二指肠切除术中转开腹对近期预后的影响及风险分析

Analysis of short-term prognosis and risk for conversion to laparotomy in laparoscopic pancreaticoduodenectomy

目的比较开腹胰十二指肠切除术(OPD)、腹腔镜胰十二指肠切除术(LPD)、LPD中转OPD的围手术期情况,分析LPD中转OPD的近期预后及危险因素。方法回顾性分析2020年2月—2023年3月首都医科大学附属北京友谊医院收治的167例施行胰十二指肠切除术(PD)患者的临床资料,其中63例患者接受OPD手术(OPD组),91例接受LPD手术(LPD组),13例患者于LPD手术过程中转为开腹手术(LPD中转OPD组)。非正态分布的计量资料以中位数(四分位间距)[M(Q1,Q3)]表示,多组间比较采用Kruskal-WallisH检验。计数资料以例数和百分比[例(%)]表示,无序分类变量采用χ^(2)检验,有序分类(等级)变量采用Kruskal-WallisH检验。LPD中转OPD危险因素采用多因素Logistic回归分析。结果LPD中转OPD组患者的术中出血量[600(350,1000)mL]、胆肠引流管留置时间[10(8,15)d]及胆肠引流管引流量[995(505,1502)mL]显著多于LPD组[200(100,300)mL、7(6,10)d、450(175,874)mL],差异均具有统计学意义(P<0.05)。LPD中转OPD组患者的手术时间[335(293,385)d]显著长于OPD组[230(195,290)d],差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前是否合并慢性胰腺炎(OR=19.714)、病变最大径(OR=5.583)对LPD中转OPD手术具有显著影响(P<0.05)。结论拟行PD患者在技术及本身条件允许的情况下应首选LPD方案。术前合并慢性胰腺炎、病变最大径>3.5 cm是LPD中转OPD的危险因素,可能显著增加术中出血量、延长胆肠引流管留置时间、增加胆肠引流管引流量,应慎重选择手术方式。

ObjectiveTo compare the perioperative conditions of open pancreaticoduodenectomy(OPD),laparoscopic pancreaticoduodenectomy(LPD)and LPD conversion OPD,and analyze the short-term prognosis and risk factors for LPD conversion OPD.MethodsThe clinical data of 167 patients undergoing pancreaticoduodenectomy(PD)in the Beijing Friendship Hospital,Capital Medical University from February 2020 to March 2023 were retrospectively analyzed.Of 167 patients,63 patients underwent OPD surgery(OPD group),91 patients underwent LPD surgery(LPD group),and 13 patients were converted to OPD during LPD surgery(LPD conversion OPD group).The measurement data with non-normal distribution were expressed as median(interquartile range)[M(Q 1,Q 3)],and comparison between groups was analyzed using the Kruskal-Wallis H test.The count data were expressed as the number of cases and percentage,and the Chi-square test was used for ordered categorical variable,Kruskal-Wallis H test was used for un-ordered categorical variable.The risk factors of LPD conversion OPD were analyzed by multivariate Logistic regression.ResultsThe intraoperative blood loss[600(350,1000)mL],bilio-intestinal drainage stay time[10(8,15)d]and bilio-intestinal drainage volume[995(505,1502)mL]in the LPD conversion OPD group were significantly higher than those in the LPD group[200(100,300)mL,7(6,6)10)d,450(175,874)mL],the differences were statistically significant(P<0.05).The operation time of the LPD conversion OPD group[335(293,385)d]was significantly longer than that of the OPD group[230(195,290)d],and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis revealed that preoperative complications of chronic pancreatitis(OR=19.714)and maximum diameter of the lesion(OR=5.583)has a significant impact on the LPD conversion OPD(P<0.05).ConclusionsPatients who plan to undergo PD should prefer LPD if the technology and physical condition permit.Preoperative complication of chronic pancreatitis,maximum diameter of lesion>3.5 cm are the risk factors for LPD conversion OPD,which may significantly increase intraoperative blood loss,prolong the indwelling time of biliary drainage tube,and increase the drainage volume of biliary drainage tube.Therefore,the surgical method should be carefully selected.