摘要
目的:探究Easy First策略在新辅助化疗后腹腔镜胰十二指肠切除术（LPD）中的临床疗效。方法:回顾性分析2019年1月至2021年12月收治的可切除或交界性可切除胰腺癌患者60例资料，所有患者均在新辅助化疗后行LPD，根据手术方法不同分为观察组（n=29例）和传统组（n=31例），观察组采用Easy First策略，术中优先处理胃、空肠和胆总管等，最后处理胰颈及胰腺钩突等顺序完成手术；传统组行传统LPD。采用SPSS 24.0完成数据分析。并发症等计数资料用[例（%）]表示，组间比较采用χ2检验；围手术期指标等计量资料用（）表示，组间比较以独立样本t检验；采用Kaplan-Meier法、Log-Rank检验进行生存分析。P<0.05差异有统计学意义。结果:观察组术中出血量显著少于传统组，引流管拔除时间短于传统组（P<0.05）；两组患者手术时间、输血、淋巴结清扫数目、术后住院时间比较，差异均无统计学意义（P>0.05）；观察组并发症总发生率虽低于传统组（6.9% vs. 22.6%），但组间差异无统计学意义（P>0.05）；两组患者累积总生存率比较（44.8% vs. 38.7%），差异无统计学意义（Log-Rank χ2=1.437，P=0.231）。结论:在新辅助化疗后LPD术中应用Easy First策略，可在术中及时控制出血，提高手术安全性，相比传统手术方法，更适用于新辅助化疗后局部组织粘连、炎症水肿明显的患者。
Abstract
Objective:To explore the clinical efficacy of Easy First strategy in laparoscopic pancreaticoduodenectomy (LPD) after neoadjuvant chemotherapy.Methods:Data of 60 patients with resectable or borderline resectable pancreatic cancer treated from January 2019 to December 2021 were retrospectively analyzed. All patients received LPD after neoadjuvant chemotherapy and were divided into observation group (n=29 cases) and traditional group (n=31 cases) according to different surgical methods. Easy First strategy was adopted in the observation group. The stomach, jejunum and common bile duct were treated first, and the neck of pancreas and uncinate process of pancreas were treated last. Traditional group row traditional LPD. SPSS 24.0 was used to complete the data analysis. Complications and other statistical data were represented by [cases (%)], and χ2 test was used for comparison between groups. Perioperative indicators and other measurement data were represented by (), and inter-group comparison was conducted by independent sample t test. Kaplan-Meier method and Log-Rank test were used for survival analysis. P<0.05 was statistically significant.Results:The intraoperative blood loss in the observation group was significantly less than that in the traditional group, and the drainage tube removal time was shorter than that in the traditional group (P<0.05). There were no significant differences in operation time, blood transfusion, number of lymph node dissection and postoperative hospital stay between the two groups (P>0.05). The total incidence of complications in the observation group was lower than that in the traditional group (6.9% vs. 22.6%), but there was no significant difference between the two groups (P>0.05). There was no significant difference in cumulative overall survival between the two groups (44.8% vs. 38.7%) (Log-Rankχ2 =1.437, P=0.231).Conclusion:The application of Easy First strategy in LPD after neoadjuvant chemotherapy can control bleeding in time and improve surgical safety. Compared with traditional surgical methods, EASY First strategy is more suitable for patients with local tissue adhesion, inflammation and edema obvious after neoadjuvant chemotherapy.
万方数据