腹腔镜与传统开腹胰体尾切除术临床疗效对比分析

发布时间：2018-08-04 21:53

【摘要】：目的:目前,对于胰腺体尾部疾病尤其是胰腺导管腺癌等恶性肿瘤行手术治疗是胰腺外科的主要方法。其中应用最广、疗效最确切的是传统开腹胰体尾部切除术(open distal pancreatectomy,0DP)。但随着近20年来腹腔镜技术的蓬勃发展,腹腔镜胰腺微创技术正越来越多应用于治疗胰腺体尾部良性、恶性肿瘤。对于腹腔镜下胰体尾切除术(laparoscopic distal pancreatectomy,LDP)手术可行性、安全性及临床疗效的争论与研究也逐渐增多。本研究通过比较分析LDP组与ODP患者术前、术中、术后的相关临床病理资料,比较两种手术方式对于治疗胰体尾部肿瘤临床疗效的差异,进而评价LDP的临床应用价值。方法:收集青岛大学附属医院肝胆外科、普外科、器官移植中心自2011年1月至2016年6月所行232例胰体尾部切除术患者的临床资料,其中LDP患者67例,ODP患者165例。在最初所选行LDP的患者中,有11例行腹腔镜中转开腹手术(中转率12.5%),按最终治疗手段区分将其纳入ODP组。去除29例联合脏器切除患者(术中联合其他脏器切除,包括胃、结肠、肾、肝脏等),共有203例患者纳入统计分析。最终LDP患者65例,ODP患者138例。所有患者术前、术中、术后与研究相关的临床指标无缺失。比较分析两组患者术前临床相关指标,为减少两组患者疾病恶性率不同所致偏倚,将两组手术患者按良、恶性疾病进行分组研究,分别比较两组患者良恶性疾病的手术相关指标及其术后恢复情况并应用SPSS 23.0软件进行统计学分析、确定两者有无统计学差异,进而研究两种手术方式的临床疗效。结果:LDP组与ODP组患者术前基本资料如年龄、性别、BMI、术前糖尿病史、上腹手术史、术前白蛋白、术前血红蛋白等相关指标无显著差异(P0.05)。临床病理结果研究显示ODP组患者疾病恶性率明显高于LDP组患者(59.4%VS 32.3%,P0.05)、肿瘤体积LDP组患者大于ODP组患者(P0.05)。分别对两组患者中良、恶性疾病相关指标对比分析可见:对于胰腺良性疾病及恶性疾病,相较于ODP组,LDP组患者手术时间长、手术费用高(P0.05),术中有无输血两者无差异(P0.05)。对于良性肿瘤,LDP术中出血量明显少于ODP(P0.05):对于胰腺恶性肿瘤,LDP术中出血量与ODP组无差异(P0.05)。但是,LDP组患者术中保脾率高(P0.05),术后住院时间、术后进食时间、引流管拔除时间短(P0.05)。术后出血、切口感染、胰瘘等并发症发生率以及围手术期死亡率等与ODP组患者无差异(P0.05)。结论:LDP并未增加手术患者术后并发症发生率,淋巴结清扫率、RO切除率与ODP效果相同,但LDP患者术后恢复快。LDP对于胰体尾部肿瘤是一种安全、有效的手术方式。LDP临床疗效优于ODP、短期预后也优于ODP。但其长期疗效仍待进一步研究。
[Abstract]:Objective: at present, surgical treatment of pancreatic body and tail diseases, especially pancreatic ductal adenocarcinoma, is the main method of pancreatic surgery. Among them, (open distal pancreatectomy0DP was the most widely used and the most effective one was traditional open pancreatectomy (open distal pancreatectomy0DP). However, with the rapid development of laparoscopic technique in recent 20 years, laparoscopic minimally invasive pancreatic technique has been applied more and more in the treatment of benign and malignant tumors of pancreatic body and tail. The feasibility, safety and clinical efficacy of laparoscopic resection of the body and tail of pancreas (laparoscopic distal pancreatectomytomy) were also increased. This study compared the clinical and pathological data between LDP group and ODP patients before, during and after operation, and compared the difference between the two surgical methods in treating pancreatic body and tail tumor, and then evaluated the clinical application value of LDP. Methods: from January 2011 to June 2016, 232 patients underwent hepatobiliary surgery, general surgery and organ transplantation in the affiliated Hospital of Qingdao University, including 67 patients with LDP and 165 patients with ODP. Among the patients who were initially selected for LDP, 11 patients underwent laparoscopic conversion to open surgery (conversion rate was 12.5%), which was included in the ODP group according to the final treatment. A total of 203 patients were included in the statistical analysis after removal of 29 cases of combined organ resection (intraoperative resection of other organs, including stomach, colon, kidney, liver, etc.). Finally, there were 65 patients with LDP and 138 patients with ODP. In all patients, there was no absence of clinical parameters related to the study before, during and after operation. In order to reduce the bias caused by the difference in the malignant rate of the two groups of patients, the two groups of patients were divided into two groups according to benign and malignant diseases. The related indexes and postoperative recovery of benign and malignant diseases in the two groups were compared, and the statistical analysis was carried out by using SPSS 23. 0 software to determine whether there was statistical difference between the two groups, and then to study the clinical effect of the two kinds of operation methods. Results there was no significant difference in preoperative basic data such as age, sex, history of diabetes mellitus, history of upper abdominal surgery, preoperative albumin and preoperative hemoglobin between the two groups (P0.05). The clinicopathological results showed that the malignant rate of ODP group was significantly higher than that of LDP group (59.4%VS 32.3g / P0.05), and the tumor volume of LDP group was higher than that of ODP group (P0.05). For benign and malignant pancreatic diseases, compared with ODP group, the operation time was longer, the operation cost was high (P0.05), and there was no difference between the two groups (P0.05). The amount of intraoperative bleeding for benign tumors was significantly less than that for ODP (P0.05); for pancreatic malignant tumors, there was no difference between LDP and ODP (P0.05). But in LDP group, the rate of spleen preservation during operation was high (P0.05), postoperative hospitalization time, postoperative feeding time and extubation time of drainage tube were short (P0.05). The incidence of postoperative bleeding, incision infection, pancreatic fistula and perioperative mortality were not significantly different from those in ODP group (P0.05). Conclusion the postoperative complications were not increased in patients with LDP, and the lymph node dissection rate and RO resection rate were the same as those of ODP, but the recovery of LDP patients was safe for tumors of the body and tail of pancreas. The clinical efficacy of LDP was better than that of ODP, and the short term prognosis was better than that of ODP. But its long-term curative effect still needs further research.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

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