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目的:评估腹腔镜胰体尾切除术安全有效性,对比腹腔镜胰体尾切除术与开腹胰体尾切除术治疗胰腺体尾部良性或低度恶性病变临床疗效。创新点:本研究为回顾性对照研究,相较于过往腹腔镜胰体尾切除术与开腹胰体尾切除术的对照研究,其创新点一为本组91例病例均为良性或低度恶性病例,剔除了恶性病变病例;二为本研究中腹腔镜胰体尾切除术组及开腹胰体尾切除术组分别由两家大型综合医院胰腺疾病诊治中心的两组医生分别施行手术,这样避免了病人及手术方式选择等造成的影响,结果更为客观。方法:回顾分析自2010年1月至2012年12月浙江大学医学院附属邵逸夫医院45例施行腹腔镜胰体尾切除术治疗胰腺体尾部良性或低度恶性病变病例(LDP组),以及同期上海复旦大学附属中山医院46例施行开腹胰体尾切除术胰腺体尾部良性或低度恶性病变病例(ODP组)的相关临床资料,进行对照研究。结论:本研究包括胰腺体尾部良性或低度恶性病例91例,其中LDP组45例(无中转开腹)和ODP组46例。手术时间分别为(158.7±38.3)min(LDP组)和(92.2±24.1)min(ODP组);术中出血LDP组明显少于ODP组((122.6±61.1)ml vs.(203.1±84.8)ml,P<0.001)。两组保脾率相似(53.3%vs.47.8%,P=0.35),其中LDP组中保脾病例均保留脾血管。在术后恢复指标方面,LDP组优于ODP组,恢复进食流质时间((1.6±0.5)d vs.(3.2±0.7)d,P<0.01)及恢复活动时间((1.8±0.4)d vs.(2.1±0.6)d,P=0.02)较短,且LDP组术后住院时间也少于ODP组((7.9±3.8)d vs.(11.9±5.8)d,P=0.006)。术后胰瘘率两组无明显差异(15.6%vs.19.6%,P=0.62),但术中总并发症率LDP组低于ODP组(26.7%vs.47.8%,P=0.04)。研究结果显示腹腔镜胰体尾切除术治疗胰腺体尾部良性或低度恶性肿瘤安全可行,与开腹胰体尾切除术术相比术中出血更少、术后恢复更快,具有明显微创优势。
Objective: To evaluate the safety and efficacy of laparoscopic pancreatic tail resection. To compare the clinical efficacy of laparoscopic pan-pancreatic tail resection and open pancreatectomy for the treatment of benign or malignant lesions in the tail of the pancreas. Innovative point: This study is a retrospective, controlled study, compared with the previous laparoscopic pancreatic tail resection and open pancreatectomy resection of the control study, the innovation of a group of 91 cases were benign or low Malignant cases, excluding cases of malignant lesions; Second, in this study, laparoscopic pancreaticotomosurgical resection group and open pancreatectomy group were operated by two groups of doctors in two large general hospital pancreatic disease diagnosis and treatment center respectively, This avoids the patient and the choice of surgical effects, the result is more objective. Methods: From January 2010 to December 2012, 45 cases of pancreatic end-tail benign or low-grade malignant lesions (LDP group) underwent laparoscopic pan-pancreatic tail resection were performed in 45 cases of Run Run Shaw Hospital of Zhejiang University School of Medicine, Forty-six cases of Zhongshan Hospital affiliated to Fudan University in Shanghai were enrolled in the comparative study of benign or low-grade pancreatic body lesions (ODP group) with pancreatic body tail resection. Conclusions: This study included 91 cases of benign or low-grade malignant tumors in the tail of the pancreas, including 45 cases in the LDP group (no laparotomy) and 46 cases in the ODP group. The operative time was (158.7 ± 38.3) min (LDP group) and (92.2 ± 24.1) min (ODP group) respectively. The intraoperative bleeding in LDP group was significantly less than that in ODP group (122.6 ± 61.1) ml vs. (203.1 ± 84.8) ml, P <0.001). The spleen retention rate was similar between the two groups (53.3% vs.47.8%, P = 0.35). In terms of postoperative recovery indicators, the LDP group was superior to the ODP group in terms of recovery time of feeding fluid ((1.6 ± 0.5) d vs. (3.2 ± 0.7) d, P <0.01) and recovery activity time (1.8 ± 0.4 d vs (2.1 ± 0.6) d, P = 0.02), and the postoperative hospital stay in LDP group was also less than that in ODP group (7.9 ± 3.8 d vs. (11.9 ± 5.8) d, P = 0.006). The rate of postoperative pancreatic fistula was no significant difference between the two groups (15.6% vs.19.6%, P = 0.62). However, the total intraoperative complication rate in LDP group was lower than that in ODP group (26.7% vs.47.8%, P = 0.04). The results show that laparoscopic pancreaticotomized resection of benign or malignant tumors of the tail and body of the pancreas safe and feasible, compared with open pancreatectomy resection surgery less bleeding, postoperative recovery faster, with minimally invasive Advantage.