摘要
目的 分析腹腔镜胰腺局部切除术治疗胰头囊性肿瘤的安全性及有效性.方法 回顾性分析2017年2月至2022年10月在河北医科大学第二医院肝胆外科行腹腔镜手术的胰头囊性肿瘤患者资料.共入组83例患者,其中男性30例,女性53例,年龄(43.7±16.7)岁.83例患者根据术式不同分为观察组(n=55)和对照组(n=28).观察组行腹腔镜胰腺局部切除术(腹腔镜保留十二指肠的胰头切除术或腹腔镜胰头肿瘤摘除术),对照组行腹腔镜胰十二指肠切除术.比较两组年龄、性别、体质量指数、术后住院时间、带引流管出院比例、手术时间、术中出血量、术中输血率以及术后胰瘘等.结果 所有患者均顺利完成手术,无中转开腹及围手术期死亡.两组患者年龄、男性比例、体质量指数、术后住院时间、带引流管出院比例等比较,差异均无统计学意义(均P＞0.05).观察组的手术时间为(194.4±114.0)min、术中出血量为50(50,200)ml、术中输血率为5.5％(3/55),均优于对照组的(380.0±71.6)min、200(100,400)ml、32.1％(9/28),差异均有统计学意义(均 P＜0.05).观察组和对照组的B或C级胰瘘发生率分别为12.7％(7/55)、10.7％(3/28),两组比较差异无统计学意义(P=0.790).结论 与传统的腹腔镜胰十二指肠切除术相比,腹腔镜胰腺局部切除术可以缩短手术时间、减少术中出血量及降低术中输血率,并且B或C级胰瘘无明显差异.
Abstract
Objective To explore the safety and effectiveness of laparoscopic local pancreatectomy in the treatment of cystic neoplasms of pancreatic head.Methods Retrospective analysis was conducted of data on patients with pancreatic head cystic neoplasms who received laparoscopic surgery at the Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University from February 2017 to October 2022.A total of 83 patients were enrolled,including 30 males and 53 females,aged(43.7±16.7)years old.All patients were divided into an observation group(n=55)and a control group(n=28)based on dif-ferent surgical procedures.The observation group underwent laparoscopic local pancreatectomy(laparoscopic duodenum-preserving pancreatic head resection or laparoscopic enucleation),while the control group under-went laparoscopic pancreaticoduodenectomy(LPD).The age,gender,body mass index,postoperative hos-pital stay,proportion of discharged patients with drainage tubes,surgical time,intraoperative blood loss,intraoperative blood transfusion rate,and fistula were compared between two groups.Results All patients successfully completed the surgery,and there were no cases of conversion to laparotomy or perioperative deaths.There was no statistically significant difference in age,male proportion,body mass index,postopera-tive hospital stay,and discharge rate with drainage tube between the two groups of patients(all P＞0.05).The observation group had a surgical time of(194.4±114.0)min,intraoperative bleeding of 50(50,200)ml,and intraoperative blood transfusion rate of 5.5％(3/55),all of which were better than that of the con-trol group,(380.0±71.6)min,200(100,400)ml,and 32.1％(9/28),with statistical significance(all P＜0.05).Amongthem,theB/C fistula rates in the laparoscopic local pancreatectomy group and LPD group were 12.7％(7/55)and 10.7％(3/28)(P=0.790),respectively.Conclusion Compared with traditional LPD,laparoscopic local pancreatectomy can shorten surgical time,reduce intraoperative bleed-ing,and lower intraoperative blood transfusion rate.And there is no significant disadvantage in the B or C grade fistula.
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