完全腹腔镜胰十二指肠切除术的近期疗效分析

目的比较完全腹腔镜与开腹胰十二指肠切除术的疗效,探讨完全腹腔镜胰十二指肠切除术的安全性和可行性。方法回顾性分析2016年1月~2018年10月胰十二指肠切除术资料,其中50例完全腹腔镜手术,58例开腹手术。2组肿瘤部位、病理类型、肿瘤最大径差异均无显著性(P>0.05)。比较2组围手术期和随访结果。结果与开腹组相比,腹腔镜组手术时间长(393.5±72.9)min vs.(247.0±61.9)min,t=11.300,P=0.000],胰肠吻合时间长(47.2±9.2)min vs.(28.5±7.0)min,t=11.951,P=0.000],而术后排气早(3.4±1.0)d vs.(4.6±1.2)d,t=-5.534,P=0.002],进流食早(5.1±2.3)d vs.(7.5±2.2)d,t=-5.280,P=0.000],拔除胃管早(5.1±2.2)d vs.(9.4±4.2)d,t=-6.878,P=0.000],下床活动早(2.0±1.2)d vs.(3.3±1.1)d,t=-5.928,P=0.000],术后住院时间短(14.7±5.4)d vs.(18.9±10.5)d,t=-2.515,P=0.046],切口感染发生率低(0%vs.13.8%,P=0.007)。2组术后B级及以上胰漏(22.0%vs.15.5%)及总并发症发生率(36.0%vs.31.0%)差异无显著性(P>0.05)。2组恶性肿瘤清扫淋巴结数目、肿瘤分期和R0切除率差异均无显著性(P>0.05)。86例恶性肿瘤随访3~30个月,中位数18个月。2组术后总生存率(OS)和无进展生存率(PFS)差异均无显著性(log-rankχ^2=0.010,P=0.921;log-rankχ^2=0.148,P=0.701)。结论完全腹腔镜胰十二指肠切除术在肿瘤根治效果、并发症发生率、预后等方面与开腹手术无显著差异,且具有术后恢复快、住院时间短等优势,安全可行。

Clinical Short-term Outcomes of Total Laparoscopic Pancreaticoduodenectomy

Objective To compare the clinical outcomes of total laparoscopic pancreaticoduodenectomy(TLPD)and open pancreaticoduodenectomy(OPD),and to investigate the safety and feasibility of TLPD.Methods The clinical data of cases who underwent TLPD(n=50)or OPD(n=58)between January 2016 and October 2018 were analyzed retrospectively.There was no significant difference in tumor site,pathological type and maximum tumor diameter between the two groups(P>0.05).The perioperative outcomes and follow-ups were compared between the two groups.Results As compared to the OPD group,the TLPD group showed longer operative time(393.5±72.9)min vs.(247.0±61.9)min,t=11.300,P=0.000],longer pancreaticojejunostomy time(47.2±9.2)min vs.(28.5±7.0)min,t=11.951,P=0.000],earlier postoperative exhaust(3.4±1.0)d vs.(4.6±1.2)d,t=-5.534,P=0.002],earlier oral intake(5.1±2.3)d vs.(7.5±2.2)d,t=-5.280,P=0.000],earlier nasogastric tube removal(5.1±2.2)d vs.(9.4±4.2)d,t=-6.878,P=0.000],earlier postoperative out-of-bed activity(2.0±1.2)d vs.(3.3±1.1)d,t=-5.928,P=0.000],and shorter postoperative hospital stay(14.7±5.4)d vs.(18.9±10.5)d,t=-2.515,P=0.046].The incidence of incision infection in the TLPD group was significantly lower than that in the OPD group(0%vs.13.8%,P=0.007).There were no significant differences in the incidence of grade B or higher postoperative pancreatic leakage(22.0%vs.15.5%)and total complications(36.0%vs.31.0%)between the two groups(P>0.05).Between the two groups of malignant tumor,there were no significant differences in lymph nodes harvested,tumor stages,and R0 resection rates(P>0.05).A total of 86 patients with malignant tumor were followed up for 3-30 months with a median time of 18 months.There was no significant difference in overall survival(OS)and progression-free survival(PFS)between the two groups(log-rankχ^2=0.010,P=0.921;log-rankχ^2=0.148,P=0.701).Conclusions Compared with OPD,TLPD not only confers similar oncological outcomes,complication rate and prognosis,but also has advantages such as faster postoperative recovery and shorter hospital stay.TLPD is safe and feasible in clinical practice.