腹腔镜在胰腺假性囊肿治疗中的应用

发布时间：2019-02-21 09:03

【摘要】：目的:分析腹腔镜胰腺假性囊肿内引流术(laparoscopic internal drainage of pancreatic pseudocysts,LIDP)与开腹胰腺假性囊肿内引流术(open surgical internal drainage of pancreatic pseudocysts,OSIDP)的临床疗效,评价腹腔镜胰腺假性囊肿内引流术的可行性、安全性及优越性,以发展腹腔镜在胰腺假性囊肿治疗中的广泛应用。方法:回顾性分析2011年6月至2016年8月就诊于吉林大学中日联谊医院和吉林大学第二医院肝胆胰外科行内引流术的46例胰腺假性囊肿患者的临床资料,其中22例行腹腔镜胰腺假性囊肿内引流术标记为腹腔镜组(LIDP),24例行开腹胰腺假性囊肿内引流术标记为开腹组(OSIDP)。比较并分析两组患者的术前一般情况(性别、年龄、囊肿大小)、术中情况(手术时间、出血量)及术后情况(首次排气时间、首次进食时间、术后住院时间、住院费用及并发症等)的差异。结果:两组患者术前一般情况(性别、年龄、囊肿大小等)差异无统计学意义(P0.05);LIDP组和OSIDP组患者平均手术时间分别为(121.13±25.53)min和(130.83±14.34)min(P0.05);术中平均出血量分别为(87.72±24.48)ml和(103.75±26.83)ml(P0.05);术后首次排气时间分别为(3.00±1.02)d和(3.79±1.10)d(P0.05);术后进食时间分别为(3.09±0.97)d和(3.87±0.99)d(P0.05);术后住院时间分别为(4.90±1.54)d和(8.66±3.71)d(P0.05);住院费用分别为(43402.06±6424.47)元和(37668.45±11249.01)元(P0.05);LIDP组22例患者术后并发症2例(发生率为9.09%),2例均为生化漏,其余患者无并发症发生;OSIDP组24例患者术后出现并发症者有4例(发生率为16.67%),生化漏2例,B级胰瘘2例,其中2例为胰瘘合并出血。结论:腹腔镜胰腺假性囊肿内引流术具有创伤小、视野清晰直观、术中出血量少、术后恢复快、住院时间短、并发症发生率低的优势;腹腔镜胰腺假性囊肿内引流术较开腹内引流术没有增加手术时间,但平均住院费用有所增加;该术式简单易行,对手术设备及器械要求不高,只要严格掌握手术适应症,并选择恰当的手术方式,该术式是安全可行的,具有推广应用价值。
[Abstract]:Objective: to analyze the clinical effect of laparoscopic pancreatic pseudocyst drainage (laparoscopic internal drainage of pancreatic pseudocysts,LIDP) and open pancreatic pseudocyst drainage (open surgical internal drainage of pancreatic pseudocysts,OSIDP). To evaluate the feasibility, safety and superiority of laparoscopic drainage of pancreatic pseudocyst, so as to develop the wide application of laparoscopy in the treatment of pancreatic pseudocyst. Methods: from June 2011 to August 2016, 46 patients with pancreatic pseudocyst underwent internal drainage in the Department of Hepatobiliary and Pancreatic surgery, Sino-Japanese Friendship Hospital of Jilin University and the second Hospital of Jilin University, were retrospectively analyzed. 22 cases of laparoscopic pancreatic pseudocyst internal drainage labeled as laparoscopic group (LIDP), 24 cases of open pancreatic pseudocyst internal drainage labeled open group (OSIDP). The preoperative general condition (sex, age, cyst size), intraoperative condition (operation time, bleeding volume) and postoperative condition (first exhaust time, first feeding time, postoperative hospitalization time) were compared and analyzed between the two groups. Differences in hospital expenses and complications. Results: there was no significant difference between the two groups in preoperative general conditions (sex, age, cyst size, etc.) (P0.05). The mean operative time was (121.13 卤25.53) min and (130.83 卤14.34) min () in LIDP group and (130.83 卤14.34) min (in OSIDP group, and the mean intraoperative blood loss was (87.72 卤24.48) ml and (103.75 卤26.83) ml (, P0.05) in LIDP group and OSIDP group, respectively. The first time of venting after operation was (3.00 卤1.02) d and (3.79 卤1.10) d (), the time of feeding after operation was (3.09 卤0.97) d and (3.87 卤0.99) d (), respectively. The postoperative hospitalization time was (4.90 卤1.54) days and (8.66 卤3.71) d (, respectively, and the hospitalization expenses were (43402.06 卤6424.47) yuan and (37668.45 卤11249.01) yuan (P0.05), respectively. In LIDP group, 2 cases (9.09%) had postoperative complications, 2 cases were biochemical leakage, and no complication occurred in other patients. In OSIDP group, there were 4 cases (16.67%) with postoperative complications, 2 cases with biochemical leakage, 2 cases with B grade pancreatic fistula, 2 cases with pancreatic fistula complicated with hemorrhage. Conclusion: laparoscopic pancreatic pseudocyst drainage has the advantages of less trauma, clear visual field, less intraoperative bleeding, quick postoperative recovery, short hospital stay and low incidence of complications. Laparoscopic pancreatic pseudocyst drainage had no longer operation time than open abdominal drainage, but the average hospitalization cost was increased. The operation method is simple and easy to carry out. It is safe and feasible and has the value of popularization and application as long as the indication of operation is strictly grasped and the appropriate operation method is selected.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.5

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