【作者】 陈超；

【导师】 王禹；

【作者基本信息】 吉林大学 ， 临床医学硕士（外科学）（专业学位）， 2019， 硕士

【摘要】 目的:通过对腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)和开腹胰十二指肠切除术(Open pancreaticoduodenectomy,OPD)在治疗胰腺癌及壶腹周围肿瘤的两组临床资料进行收集、整理、统计;比较分析腹腔镜胰十二指肠切除术和开腹胰十二指肠切除术在治疗胰腺癌及壶腹周围肿瘤的疗效差异,来证实腹腔镜胰十二指肠切除术是否安全可行,是否能够同其他腹腔镜手术一样取得微创效果并符合肿瘤根治性原则,为临床腹腔镜手术治疗胰腺癌及壶腹周围肿瘤提供一定的指导意义。方法:回顾性分析2017年1月1日至2018年12月31日在吉林大学第二医院接受胰十二指肠切除术患者共66例,其中排除术后病理诊断为炎症或胰管结石患者7例,中转开腹1例后,共58例患者被纳入本次研究,腹腔镜手术23例,开腹手术35例,对腹腔镜胰十二指肠切除术组(LPD组)与开腹胰十二指肠切除术组(OPD组)病例的患者术前基础资料、术前ASA评分、手术时间、住院时间、住院费用、术中输血量、术中切除淋巴结数及淋巴结阳性率、术后病理、术后住ICU时间、术后止痛次数、术后首次排气时间、术后首次进流食时间、术后发热次数、术后并发症等方面的情况进行统计分析,得出结论。结果:LPD组23例,其中男性10例,女性23例,年龄(59.87±7.36)岁;OPD组35例,其中男性21例,女性14例,年龄(62.94±9.68)岁;术前ASA评分,LPD组Ⅰ级13例,Ⅱ级8例,Ⅲ级2例;OPD组Ⅰ级13例,Ⅱ级16例,Ⅲ级6例。两组的术前资料(包括性别、年龄、ASA评分)均无统计学差异,两组数据具有可比性。术中及术后资料如下,手术时间:LPD组(551.87±76.40)min vs.OPD组(306.00±64.748)min,P﹤0.001;术中输血量:LPD组(390.43±96.25)ml vs.OPD(338.86±55.59)ml,P=0.621;术后住ICU时间:LPD组(0.13±0.95)d vs.OPD组(0.03±0.03)d,P=0.234;术后发热:LPD组(2.30±0.54)次vs.OPD组(2.03±0.58)次,P=0.742;术后排气时间:LPD组(5.05±0.48)d vs.OPD组(5.83±0.38)d,P=0.199;术后进流食时间:LPD组(8.70±0.58)d vs.OPD组(12.80±1.33)d,P=0.007;术后住院时间:LPD组(16.87±0.96)d vs.OPD组(23.17±3.26)d,P=0.131;住院费用:LPD组(114018.59±5436.98)元vs.OPD组(94846.25±5828.52)元,P=0.027;切除淋巴结数:LPD组(12.09±1.38)组vs.OPD组(14.83±1.51)组,P=0.213;阳性淋巴结数:LPD组(0.83±0.22)组vs.OPD组(0.63±0.19)组,P=0.512;胰漏、胆漏、术后出血、乳糜瘘、胃排空障碍、肺部感染、切口感染、切口脂肪液化、胸腔积液、腹腔积液、应激性溃疡等并发症的发生率和总并发症发生率差异均无显著性。两组入选患者均已达到R0切除,均无围手术期死亡。结论:1、通过分析LPD与OPD在治疗胰头癌及壶腹周围癌患者中的治疗效果,LPD组手术时间较长,住院费用较高,但是术后恢复进食时间早,而术中平均出血量、术中输血率、术中清扫淋巴结数、术后住ICU时间、术后平均住院时间、术后镇痛次数、术后首次排气时间、术后发热次数、术后并发症发生率与OPD组无明显差异。2、LPD手术较为复杂,且相比其他腹部手术,学习曲线相对较长,因此需要严格把握手术适应症,要求较固定的手术团队以及丰富的手术经验。3、相比LPD开展初期,手术时长、术后并发症等已经取得了巨大的进步,随诊腹腔镜技术的不断进步与手术器械、吻合技术的不断改进,加之其本身微创所带来的优势,LPD的优势会愈发的明显。4、LPD仍是目前普外科最复杂与困难的手术,但手术的安全性、可行性及有效性已经得到证实,在具有丰富经验及技术条件的大型诊疗中心可以推广开展。更多还原

【Abstract】 Objective:The clinical data of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in the treatment of pancreatic cancer and periampullary tumors were collected,sorted and statistically analyzed.Comparative analysis of laparoscopic resection of pancreatic duodenal pancreatic duodenal resection in the treatment of pancreatic cancer and laparotomy and ampulla around tumor curative effects,to confirm that whether laparoscopic resection of pancreas duodenum is safe and feasible,whether can be the same as other laparoscopic surgery minimally invasive effect and the principle of radical tumor,laparoscopic surgery for the clinical treatment of pancreatic cancer and ampulla around tumor provide certain guiding significance.Methods:A retrospective analysis was performed on 66 patients who underwent pancreaticoduodenectomy in the second hospital of jilin university from January 2017 to January 2019.Among them,7 patients were excluded from postoperative pathological diagnosis of inflammation or pancreatic duct stones,and 1 patient was transferred to laparotomy.A total of 58 patients were included in this study.Group of laparoscopic resection of pancreatic duodenal pancreatic duodenal resection group LPD and group OPD in patients with preoperative basic data,ASA grade,operation time,intraoperative blood transfusion,length of hospital stay,hospital expenses,intraoperative resected lymph node number and amount of lymph node positive rate and postoperative pathology,postoperative ICU time,postoperative pain,postoperative exhaust time,postoperative into liquid diets for the first time for the first time time,number of postoperative fever,postoperative complications and other aspects of statistical analysis,draw the conclusion.Results:There were 23 patients in the LPD group,including 10 males and 23 females,aged 59.87 7.36 years.There were 35 patients in the OPD group,including 21 males and 14 females,aged 62.94 9.68 years.Preoperative ASA score,LPD group Ⅰ level 13 cases,Ⅱ level 8 cases,Ⅲ level 2 cases;OPD group Ⅰ level 13 cases,Ⅱ level 16 cases,Ⅲ level 6 cases.Preoperative data(including gender,age and ASA score)of the two groups were not statistically different,and the data of the two groups were comparable.Intraoperative and postoperative data were as follows.Operation time: LPD group(551.87±76.40)min vs.OPD group(306.00±64.748)min,P < 0.001;Intraoperative blood transfusion volume: LPD group(390.43 ± 96.25)ml vs.OPD(338.86 ± 55.59)ml,P=0.621;Postoperative ICU stay: LPD group(0.13±0.95)d vs.OPD group(0.03±0.03)d,P=0.234;Postoperative fever: 2.30±0.54 times in the LPD group and 2.03±0.58 times in the OPD group,P=0.742.Postoperative exhaust time: LPD group(5.05±0.48),d vs.OPD group(5.83±0.38)d,P=0.199;Postoperative feeding time: LPD group(8.70±0.58)d vs.OPD group(12.80±1.33)d,P=0.007;Postoperative hospital stay: LPD group(16.87±0.96)d vs.OPD group(23.17±3.26)d,P=0.131;Hospitalization cost: RMB:114018.59±5436.98 for LPD group vs.RMB:94846.25±5828.52 for OPD group,P=0.027;Number of lymph nodes resected: LPD group(12.09±1.38)group vs.OPD group(14.83±1.51)group,P=0.213;Positive lymph node number: LPD group(0.83±0.22)group vs.OPD group(0.63±0.19)group,P=0.512;There was no significant difference in the incidence and total incidence of complications such as pancreatic leakage,biliary leakage,postoperative bleeding,chylous fistula,gastric emptying disorder,pulmonary infection,incision infection,incision fat liquefaction,pleural effusion,peritoneal effusion and stress ulcer.R0 resection was achieved in both groups,and no perioperative death was observed.Conclusions:1、Through the analysis of LPD and OPD around the treatment of pancreatic head carcinoma and ampullary carcinoma treatment effect of moderate,LPD group of operation for a long time,hospitalization cost is higher,but the eating time early,while the average intraoperative blood loss,intraoperative blood transfusion rate,intraoperative cleaning the living number of lymph nodes,postoperative ICU time,number of average hospital stay,postoperative analgesia after operation,postoperative exhaust time,postoperative fever times for the first time,postoperative complications and no difference between the two groups.2 、 LPD surgery is more complex,and compared with other abdominal surgery,the learning curve is relatively longer,so it is necessary to strictly grasp the indications,fixed surgical team and rich surgical experience.3、Compared with the initial stage of LPD,great progress has been made in surgical duration and postoperative complications,etc.With the continuous progress of laparoscopic diagnosis and the continuous improvement of surgical instruments and anastomosis technology,as well as the advantages brought by its own minimally invasive technique,the advantages of LPD will become more and more obvious.4、LPD is still the most complex and difficult surgery in general surgery at present,but the safety,feasibility and effectiveness of the surgery have been confirmed,which can be popularized in large diagnosis and treatment centers with rich experience and technical conditions.更多还原