摘要
目的:探讨"双轴十字法"模块化腹腔镜胰十二指肠切除术的可行性.方法:回顾性分析赣州市人民医院肝胆胰外科2021年1月至2023年6月行胰十二指肠切除术62例患者资料,根据手术方式将患者分为"双轴十字法"模块化腹腔镜胰十二指肠切除术(Laparoscopic pancreaticoduodenectomy,LPD)组(LPD组)和传统开腹胰十二指肠切除术(Open pancreaticoduodenectomy)组(OPD组).LPD组采用腹腔镜操作,以胰腺作为横轴探查模块,以肠系膜上静脉/门静脉作为纵轴切除模块加上重建模块共3个步骤;OPD组采用传统手术流程.分析比较2组患者的临床资料和术中术后各项指标.结果:62例患者中32例为LPD组,30例为OPD组.2组患者R0切除率均为100%,LPD组患者在术中出血量、肛门排气时间、下床活动时间、切口感染率、住院时间均优于OPD组(P＜0.05).2组年龄、性别、术前诊断、手术时间、术后出血、胃排空障碍、胆漏、B+C级胰瘘差异无统计学意义(P＞0.05).结论:"双轴十字法"模块化腹腔镜胰十二指肠切除术安全可行,可有效缩短学习曲线,值得临床推广.
Abstract
Objective:To investigate the safety and feasibility of modular laparoscopic pancreaticoduodenectomy by the"Dual-Axis cross"method.Methods:A retrospective analysis was conducted on the data of 62 patients who underwent ancreatoduodenectomy in the Department of Hepatobiliary and Pancreatic Surgery in Ganzhou People's Hospital between January 2021 and June 2023.The patients were divided into two groups according to different methods:the modular laparoscopic pancreatoduodenectomy group using the"Dual-Axis cross"(LPD group)and the traditional open pancreatoduodenectomy group(OPD group).The LPD group underwent laparoscopic surgery and utilized the pancreas as the horizontal and vertical exploration module and the superior mesenteric vein/portal vein as the longitudinal axis for resection.In addition to the reconstruction module,a total of three steps were taken.The OPD control group utilized the traditional surgical procedure.Clinical data,intraoperative,and postoperative indicators were compared between the two groups via retrospective analysis.Results:A total of 62 patients were enrolled,with 32 patients in the LPD group and 30 patients in the OPD group.The R0 resection rate was 100%in both groups.The LPD group exhibited better outcomes in terms of intraoperative bleeding,time to anal exhaust,time to mobilization,incidence of surgical site infection,and length of hospitalization compared to the OPD group(P＜0.05).There were no statistically significant differences between the two groups regarding age,gender,preoperative diagnosis,surgery time,postoperative bleeding,gastric emptying disorders,bile leakage,or B+C grade pancreatic fistula(P＞0.05).Conclusion:The modular laparoscopic pancreaticoduodenectomy utilizing the"Dual-Axis cross"method was found to be safe and feasible.This procedure effectively shortens the learning curve.It is worthy of clinical promotion.
基金项目
赣州市科技局重点研发计划项目(GZ2020-10-15)
万方数据