两种不同机器人手术方式治疗胰头部实性假乳头状瘤的对比研究

目的对比研究机器人肿瘤剜除术(robotic enucleation,REN)及机器人胰十二指肠切除术(robotic pancreaticoduodenectomy, RPD)在治疗胰头部胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas, SPT)的可行性及术后短期、长期结果。 方法选取2016年1月至2019年4月解放军总医院第一医学中心肝胆外二科收治的28例胰头部SPT患者,其中10例患者进行REN,18例患者接受RPD。回顾性分析两组患者的一般资料、手术情况、术后随访等数据,对两组进行比较和评估。 结果28例患者的中位年龄为29岁,男∶女比例为1∶8.33。REN组体质量指数值较低(P＝0.046)。两组患者均无围手术期死亡及二次手术。与RPD组相比,REN组的手术时间更短(P<0.001)、出血量更少(P＝0.009)。但两组的术后并发症率、胰瘘率、术后住院时间比较,差异均无统计学意义(P>0.05)。随访期内两组均无复发病例,REN组术后外分泌功能不全的发生率更低(P＝0.039)。 结论机器人胰头部SPT肿瘤剜除术安全可行,保留器官及功能的优势明显,不会增加术后胰瘘及其他严重并发症。对于适合的胰头部SPT患者建议首选REN治疗。

A comparative study of two different types of robotic surgery for solid pseudopapillary tumor of the head of pancreas

Objective To compare the feasibility of robotic enucleation(REN)and robotic pancreatoduodenectomy(RPD)in the treatment of solid pseudopapillary tumor of the pancreas(SPT)in the head of the pancreas and the short-term and long-term results.Methods From Jan.2016 to Apr.2019,28 patients with SPT at the head of pancreas,10 patients resected REN and 18 patients resected RPD were selected.Retrospectively analysis of the two groups of patients with general information,surgery,postoperative follow-up and other data,the two groups were compared and evaluated.Results The median age was 29 years old,and the ratio of male to female was 1∶8.33.The BMI of REN group was less(=0.046).There was no perioperative death or secondary operation in both groups.Compared with RPD group,REN group had shorter operation time(<0.001)and less bleeding(=0.009).However,there was no significant difference in postoperative complication rate,pancreatic fistula rate and postoperative hospital stay between the two groups(>0.05).During the follow-up period,there was no recurrence in both groups,and the incidence of postoperative exocrine dysfunction was lower in REN group(=0.039).Conclusions Robotic enucleation of tumor is safe and feasible,with obvious advantages of organ and function preservation,and will not increase postoperative pancreatic fistula and other serious complications.It is suggested that robotic enucleation should be the first choice for patients with SPT in the head of pancreas.