腹腔镜辅助与开放胰十二指肠切除术的近期疗效比较

目的:通过对腹腔镜辅助胰十二指肠切除术(LAPD)与开放胰十二指肠切除术(OPD)近期疗效的比较,探讨LAPD可行性及其是否符合肿瘤的根治及微创原则。方法:回顾性分析2012年5月—2014年12月79例胰十二指肠切除术(PD)患者的临床资料,其中25例行LAPD(LAPD组),54例行开放手术(OPD组),比较两组患者围术期指标。结果:与OPD组比较,LAPD组手术时间(474.6minvs.404.9min)、手术费用(2.15万元vs.1.87万元)增加,而术中出血量(265.5m L vs.380.8m L)、术中输血率(8.0%vs.29.6%)、术后止痛次数(0.56次vs.1.6次)、术后肛门排气时间(3.8d vs.5.7d)、首次进食流质时间(5.3d vs.7.6d)、住ICU时间(0.74d vs.1.3d)、住院时间(15.5d vs.19.0d)、肿瘤直径(2.0cm vs.3.9cm)均减少(均P0.05)。两组患者术后总并发症与各并发症发生率、病死率、R0切除率、术中切除淋巴结数及淋巴结阳性数差异均无统计学意义(均P0.05)。结论:LAPD虽手术复杂、难度大,但在一些选择性的病例中,对于熟练掌握OPD并有着丰富的腔镜经验医师而言,在完成一定的学习曲线后,该术式是安全可行的,符合肿瘤根治及微创原则。

Comparison of short-term efficacy of laparoscopy-assisted and open pancreaticoduodenectomy

Objective: Through comparing the short term efficacy of laparoscopy-assisted pancreaticoduodenectomy (LAPD)and open pancreaticoduodenectomy (OPD) to assess the feasibility of LAPD and its conformity to the principlesof radical cancer surgery and minimal invasiveness.Methods: The clinical data of 79 patients undergoing pancreaticoduodenectomy (PD) from May 2012 toDecember 2014 were retrospective analyzed. Of the patients, 25 cases received LAPD (LAPD group) and 54 caseshad open surgery (OPD group). The perioperative variables between the two groups were compared.Results: In LAPD group compared with OPD group, the operative time (474.6 min vs. 404.9 min), surgerycost (21 500 yuan vs. 18 700 yuan) were increased, while the intraoperative blood loss (265.5 mL vs. 380.8 mL),intraoperative transfusion rate (8.0% vs. 29.6%), times for postoperative analgesia demand (0.56 times vs. 1.6 times), time to first flatus passage (3.8 d vs. 5.7 d), time to first liquid intake (5.3 d vs. 7.6 d), length of ICU stay (0.74 d vs.1.3 d), length of hospital stay (15.5 d vs. 19.0 d) and tumor size (2.0 cm vs. 3.9 cm) were all significantly reduced (allP<0.05). There was no significance between the two groups in incidence of overall or individual complications,mortality, R0 resection rate, the number of resected lymph nodes and the number of positive lymph nodes (allP>0.05).Conclusion: Although the procedure of LAPD is complicated and troublesome, it is safe, feasible and can followthe principles of radical cancer surgery and minimal invasiveness in some selected patients, for surgeons who havea full command of OPD technique and adequate laparoscopic experience after completion of certain learningcurve.