钩突入路腹腔镜胰十二指肠切除术的安全性及可行性研究

目的探讨钩突入路腹腔镜胰十二指肠切除术的安全性及可行性。 方法回顾分析2014年1月至2016年6月行胰十二指肠切除术的76例患者资料，根据手术方式不同将患者分为开腹组和LPD组，开腹组患者36例行开腹胰十二指肠切除术，LPD组患者30例行钩突入路腹腔镜胰十二指肠切除术。采用SPSS22.0统计学软件进行分析，术后并发症等组间比较采用卡方检验或Fisher确切概率法；术中术后各项指标等以( ±s)表示，采用独立t检验。以P<0.05为差异有统计学意义。 结果病理显示，两组患者R0切除率均为100%；LPD组患者手术时间、术中出血量、下床活动时间、首次进食时间、住院时间均优于开腹组(P<0.05)。两组术后出现胰瘘、胃排空障碍、胆瘘、术后出血、术后感染的等并发症发生率比较差异无统计学意义(P>0.05)。两组患者3年总生存率比较(26.67%比36.67%)，差异无统计学意义(χ²＝3.014, P>0.05)。 结论钩突入路腹腔镜胰十二指肠切除术术中出血少、术后恢复快，且安全可行。

Clinical investigation of the safety and feasibility of laparoscopic pancreaticoduodenectomy via uncinate approach

ObjectiveTo investigate the safety and feasibility of laparoscopic pancreaticoduodenectomy via uncinate approach. MethodsFrom January 2014 to June 2016, Clinical data of 76 patients who underwent pancreaticoduodenectomy were analyzed retrospectively, including 36 patients in open group and 30 patients in LPD group according to surgical treatments. Statistical analysis were performed by using SPSS 22.0 software. Measurement data, such as intraoperative and postoperative indicators were expressed as( ±s), and were examined by using independent t test. Count data such as postoperative complications were examined by chi square test and Fisher’s exact probability method. A P value <0.05 was considered as statistically significant difference. ResultsPathological results showed that the R0 resection rate was 100% in both groups. The operation time, intraoperative blood loss, ambulation time, the first eating time and length of hospital stay in the LPD group were better than those in the open group respectively(P<0.05). There was no significant difference between the two groups in terms of incidence of postoperative complications such as pancreatic fistula, gastric emptying disorder, biliary fistula, postoperative bleeding, and postoperative infection(P>0.05). There was no significant difference between the two groups in terms of 3-year overall survival rate (26.67% vs. 36.67%) (χ²=3.014, P>0.05). ConclusionLaparoscopic pancreaticoduodenectomy via uncinate approach has advantages such as less bleeding, quick recovery and is safe and feasible.