腹腔镜与开腹胰十二指肠切除术治疗远端胆管癌疗效对比及"教科书式结局"影响因素分析
Compare the short-term and long-term outcomes and"textbook outcome(TO)"between laparoscopic pancreaticoduodenec-tomy(LPD)and open pancreaticoduodenectomy(OPD)for distal cholangiocarcinoma(dCCA)after the learning curve u-sing propensity score matching(PSM)
曹昱琨 1徐帅 1李光兵 1司伟 1于光圣 1刘军1
作者信息
- 1. 山东第一医科大学附属山东省立医院器官移植肝胆外二科,济南 250021
- 折叠
摘要
目的 本研究拟通过倾向性评分匹配方法(PSM),比较学习曲线后腹腔镜胰十二指肠切除术(LPD)与开腹胰十二指肠切除术(OPD)治疗远端胆管癌(dCCA)的近、远期预后和"教科书式结局(textbook outcome,TO)".方法 纳入2017年1月至2022年12月在本中心接受LPD和OPD治疗的dCCA患者的临床及随访资料.采用PSM方法最小化组间差异.单因素和多因素logistic回归分析确定TO的独立预后因子.结果 本研究共纳入430例患者,其中LPD组224例,OPD组206例.PSM后,两组各纳入184名患者.匹配前后,两组患者在手术时间、淋巴结清扫数目、术中输血、血管切除、R0切除、严重并发症、再入院率、30天死亡率、TO及远期预后方面均无明显统计学差异(P＞0.05).LPD较OPD具有术中出血量更少(160 vs.250mL,P＜0.001),术后住院时间更短(13 vs.16天,P＜0.001)的优势.多因素分析表明,合并基础疾病(P=0.001)、主胰管直径＞3mm(P=0.001)和手术时间＞360 min(P=0.006)是TO的独立预后因子.结论 经过学习曲线,LPD治疗dC-CA 是安全可行的,并具有术中出血少,术后恢复快等优势.
Abstract
Objective This study aimed to compare the short-term and long-term outcomes and"textbook outcome(TO)"be-tween laparoscopic pancreaticoduodenectomy(LPD)and open pancreaticoduodenectomy(OPD)for distal cholangiocarcinoma(dC-CA)after the learning curve using propensity score matching(PSM).Methods The clinical and follow-up data of dCCA patients treated with LPD and OPD in our center between January 2017 and December 2022 were collected.PSM was used to minimize selection bias.Univariate and multivariate logistic regression analysis were used to determine the independent prognostic factors of TO.Results A total of 430 patients were enrolled in this study,including 224 patients in the LPD group and 206 patients in the OPD group.After PSM,184 patients were included in each group.There were no significant differences in operation time,lymph nodes harvest,intraop-erative transfusion,vascular resection,R0 resection,major complications,readmission rate,30-day mortality,TO,and long-term prognosis between the two groups before and after matching(P＞0.05).Compared with OPD,LPD had less intraoperative blood loss(160 vs.250mL,P＜0.001)and shorter postoperative length of stay(13 vs.16 days,P＜0.001).Multivariate analysis showed that comorbidities(P=0.001),main pancreatic duct diameter＞3mm(P=0.001)and operation time＞360 min(P=0.006)were inde-pendent prognostic factors for TO.Conclusions After learning curve,LPD is safe and feasible for the treatment of dCCA,with the advantages of less intraoperative blood loss and faster postoperative recovery.
关键词
远端胆管癌/腹腔镜胰十二指肠切除术/开腹胰十二指肠切除术/倾向性评分匹配/教科书式结局Key words
distal cholangiocarcinoma/laparoscopic pancreaticoduodenectomy/open pancreaticoduodenectomy/propensity score matching/textbook outcome引用本文复制引用
出版年
2024
NETL
NSTL
万方数据