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目的:评估腹腔镜(LDP)与开腹胰体尾切除术(ODP)的并发症发生率和肿瘤清除效果。创新点:本组病例的腹腔镜手术组采用endo-GIA缓慢压榨方法处理胰腺残端,并采用根治性顺行模块化胰脾切除术,获得了较低的术后胰漏发生率和良好的手术清除效果。方法:收集4年间实施胰体尾切除手术的胰腺导管腺癌病例资料,进行回顾性分析。结论:22例胰腺导管腺癌进行了LDP手术,76例病人进行了ODP手术。比较LDP和ODP组,两组在胰漏(P=0.62)、腹腔内脓肿(P=0.44)和术后出血(P=0.34)发生率无显著性差异。LDP组和ODP组术中获取的淋巴结数量(11.2±4.6 vs.14.4±5.5,P=0.44)和淋巴结阳性病例数(36%vs.41%,P=0.71)无显著性差异。切缘阳性发生率(9%vs.13%,P=0.61)也无显著性差异。LDP组平均生存期(29.6±3.7)月,ODP组为(27.6±2.1)月,无显著性差异(P=0.35)。综上所述,腹腔镜胰体尾切除术对早期的胰腺导管癌是安全有效的。采用endo-GIA缓慢压榨方法可以预防术后胰漏发生,腹腔镜下根治性顺行模块化胰腺切除有利于肿瘤清除。腹腔镜手术可以达到和传统开腹手术相似的肿瘤清除效果。
Objective: To evaluate the incidence of complications and tumor clearance of laparoscopic (LDP) and open pancreatectomy (ODP). Innovative point: The group of patients laparoscopic surgery group using endo-GIA slow squeeze method of treatment of pancreatic stump, and the use of modular radical pancreas and spleen resection, to obtain a lower incidence of postoperative pancreatic leakage and good Surgical removal effect. Methods: The data of pancreatic ductal adenocarcinoma during 4 years after pancreaticoduodenectomy were collected and analyzed retrospectively. CONCLUSIONS: Twenty-two patients with pancreatic ductal adenocarcinoma underwent LDP surgery and 76 patients underwent ODP surgery. There was no significant difference in the incidence of pancreatic leakage (P = 0.62), intraabdominal abscess (P = 0.44) and postoperative bleeding (P = 0.34) between the LDP and ODP groups. There was no significant difference in the number of lymph nodes (11.2 ± 4.6 vs.14.4 ± 5.5, P = 0.44) and lymph node positive cases (36% vs.41%, P = 0.71) in LDP group and ODP group. The positive incidence of margins (9% vs.13%, P = 0.61) also had no significant difference. The mean survival time was 29.6 ± 3.7 months in LDP group and 27.6 ± 2.1 months in ODP group, with no significant difference (P = 0.35). In summary, laparoscopic pancreatectomy for early pancreatic ductal cancer is safe and effective. Using endo-GIA slow squeeze method can prevent the occurrence of postoperative pancreatic leakage, laparoscopic radical pan-pancreatic resection is conducive to tumor removal. Laparoscopic surgery can achieve tumor clearance similar to traditional laparotomy.