腹腔镜胰十二指肠切除术与同期开腹手术的单中心对比分析
安东均 张成 安琳 王羊 杨林 王金涛 韩立 赵宝国
摘 要
目的：比较腹腔镜胰十二指肠切除术与同期开腹手术的临床效果。
方法：回顾性分析2015年1月～2018年2月西安交通大学医学部附属咸阳市中心医院收治的82例行胰十二指肠切除术患者的临床资料，根据手术入路分为腹腔镜组（LPD组，40例）和开腹组（OPD组，42例）。观察比较2组围手术期情况，采用门诊和电话方式随访其肿瘤转归及生存状态，随访时间截至2018年12月。计数资料和率的比较采用X2检验；正态分布的计量资料以
±s表示，采用t检验。以P＜0.05为差异有统计学意义。
结果：2组患者无围手术期死亡，均成功完成预定Whipple手术，全部采用Child消化道重建吻合。比较2组患者手术完成时间及术中出血量（t=5.382，3.362，P＜0.05）差异有统计学意义，手术时间开腹组短于腹腔镜组；术中出血量开腹组多于腹腔镜组。术中输血例次及术中快速冰冻切片病理学检查切缘阴性比较（x 2=0.422，0.001，P＞0.05），2组差异无统计学意义。术后应用镇痛药例数（x2=8.652，P＜0.05）差异有统计学意义，开腹组多于腹腔镜组。术后肛门排气时间、首次进食时间、术后住院时间等比较（t=-6.332，-3.526，-1.526，P＜0.05），差异有统计学意义，腹腔镜组优于开腹组。术后病理学诊断、术后肿瘤学结果、术后并发症和2组住院总费用比较（allP＞0.05），差异无统计学意义。
结论：LPD是安全可行的，较之OPD手术创伤小，术中出血少，术后恢复速度明显快于开腹手术。随着微创外科与精准外科理念的不断深入，提倡对术前拟诊或已经明确诊断的胰头颈部癌或壶腹周围癌采用腹腔镜探查并行胰十二指肠切除术。
关键词
胰头肿瘤；壶腹部周围肿瘤；胰十二指肠切除术；腹腔镜外科
Single center comparative analysis of laparoscopic pancreatoduodenectomy and simultaneous laparotomy
AN Dongjun，ZHANG Cheng，AN Lin，WANG Yang，YANG Lin，WANG Jintao，HAN Li，ZHAO Baoguo（1.Department of hepatobiliary surgery，the Center Hospital of xianyang City，Xi'an Jiaotong University Health Science Center，Xianyang ，Shanxi 712000，China；2.School of Statistics ，Xi'an University of Finance and Economics，Xi'an 710100，China）Corresponding author:AN Dongjun，Email:3079027819@qq.com
ABSTRACT
Objective:To compare the clinical effects of laparoscopic pancreatoduodenectomy and simultaneous open surgery.
Methods:The clinical data of 82 patients with pancreaticoduodenectomy admitted to the Center Hospital of Xianyang City，Xi'an Jiaotong University Health Science from January 2015 to February 2018 were retrospectively analyzed.according to the surgical approach，they were divided into laparoscopic group（LPD group，40 cases）and open group（OPD group，42 cases）.The perioperative conditions of the two groups were ob-served and compared.the prognosis and survival status of the tumors were followed up by outpatient and telephone methods.the follow-up period was until December 2018.x2 test was used to compare the counting data with the rate.The measurement data of normal distribution is expressed as
±s，and t test is used.The difference was statistically significant with P＜0.05.
Results:No perioperative death occurred in the two groups.all patients successfully completed the scheduled Whipple operation and all underwent Child digestive tract reconstruction and anastomosis.There was statistically significant difference between the two groups in the time of operation completion and intraoperative blood loss（t=5.382，3.362，P＜0.05）.The operation time in the open group is shorter than that in the laparoscopic group.The intraoperative blood loss in the open group was more than that in the laparoscopic group.There was no significant difference between the two groups（x2=0.001，0.422，P＞0.05）when the pathological examination of intraoperative fast frozen section was negative and the number of intraoperative blood transfusions was compared.The number of postoperative analgesics（x2=8.652，P＜0.05）was significantly different，and the number of patients in the laparotomy group was more than that in the laparoscopic group.The comparison of postoperative anal exhaust time，first feeding time and postoperative hospitalization time（t=-6.332，-3.526，-1.526，P＜0.05）showed statistically significant difference，and laparoscopic group was better than open group.There was no significant difference in postoperative pathological diagnosis，postoperative oncology results，postoperative complications and total hospitalization expenses between the two groups（all P＞0.05）.
Conclusion:LPD is safe and feasible.compared with OPD，it has less trauma，less bleeding and faster recovery than open surgery.With the deepening of the concepts of minimally invasive surgery and precision surgery，laparoscopic exploration and pancreaticoduodenectomy are advocated for pancreatic head and neck cancer or periampullary cancer that is to be diagnosed before surgery or has already been clearly diagnosed.
KEY WORDS
Pancreatic head tumor；Tumors around the ampulla；Pancreaticoduodenectomy；Laparoscopic surgery
腹腔镜胰十二指肠切除术（Laparoscopic pancreaticoduodenectomy，LPD）由于其复杂的解剖、切除与消化道重建操作难度高及手术时间冗长，曾备受争议。近年来随着腹腔镜技术的进一步熟练，手术经验的积累以及腹腔镜设备与器械的更新，LPD逐渐在一些胰腺外科中心作为常规开展［1-2］。西安交通大学医学部附属咸阳市中心医院采用腹腔镜手术及同期开腹手术行胰十二指肠切除术82例，现就其治疗效果报道如下。