腹腔镜辅助下胰十二指肠切除术在十二指肠乳头癌治疗中的应用与评价

  • 摘要: 目的:探讨腹腔镜辅助下胰十二指肠切除术治疗十二指肠乳头癌的可行性及其疗效。方法:总结本院17例确诊为十二指肠乳头癌已行胰十二指肠切除术患者的围手术期的临床资料, 其中腹腔镜辅助下胰十二指肠切除术(laparoscopically-assist?ed pancreaticoduodenctomy, LAPD)7例,开腹手术患者(open pancreaticoduodenectomy,OPD)10例。分析手术方法、术中出血量、手术时间、术中难点及对策、术后恢复情况等相关指标。结果:LAPD组平均手术时间为 (334.29±32.07) min,与OPD组比较差异无统计学意(P=0.053),LAPD组手术时间和身体质量指数成正相关 (r=0.809, P=0.028)。而两组中平均失血量,输血例数、切口平均长度、平均首次离床活动时间、平均肠鸣恢复时间、平均住院时间等比较差异均有统计学意义(P均<0.05), LAPD组均优于OPD组,两组术后并发症差异无统计学意义。结论:腹腔镜辅助下胰十二指肠切除术在十二指肠乳头癌的临床应用中是安全可行的,具有一定的优势,肿瘤位置合适、体型偏瘦的病例是开展该术式的理想条件。

     

    Abstract: Application and Evaluation of Laparoscopy-assisted Pancreaticoduodenectomy in DuodenalPapillary CarcinomaFan ZHOU, Mingwen HUANG, Zhi XU, Zhiqiang LUO, Shubing ZOU, Jianghua SHAO, KaiWANGCorrespondence to: Mingwen HUANG, E-mail: jxnchmw@126.comDepartment of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, ChinaAbstract Objective: To explore the feasibility and efficacy of laparoscopically assisted pancreaticoduodenctomy ( LAPD ) inpatients with duodenal papillary carcinoma. Methods: Clinical data of 17 patients with duodenal papillary carcinoma who underwentpancreaticoduodenectomy were reviewed. Of the 17 cases, laparoscopy-assisted pancreaticoduodenctomy ( LAPD ) was conducted in 7cases and open pancreaticoduodenectomy ( OPD ) was performed in 10 cases. Various indices including the surgical method, intraopera-tive blood loss, duration of surgery, intraoperative difficulties, and postoperative recovery were analyzed. Results: There were no signif-icant differences in general clinicopathologic data, including the age and sex distribution, body mass index, tumor size, or pathologystaging between the groups. The mean duration of surgery in the LAPD group ( 334.29±32.07 min ) was similar to that in the OPDgroup ( 287.00±52.72 min, P = 0.053 ), without statistical differences between the two groups. There was a positive correlation betweenthe surgical duration and body mass index in the LAPD group ( r = 0.809, P = 0.028 ). However, there were statistically significant dif-ferences between the two groups in mean blood loss ( 112.86±62.64 ) mL vs. ( 266.50 60.28 ) mL , the number of cases requiring in-traoperative transfusion ( 1 vs. 4 ), incision length ( 7.87±1.79 ) cm vs. ( 15.20±1.62 ) cm , average time to first ambulation ( 4.14±0.69 ) d vs. ( 5.10±0.57 ) d, time to borborygmus recovery ( 3.57±0.79 ) d vs. ( 4.40±0.70 ) d , and length of postoperative hospitalstay ( 17.57±3.69 ) d vs. ( 20.80±2.25 ) d ( P < 0.05 ). All data were better in the LAPD group than in the OPD group. No significantdifferences in the postoperative complications were found between the two groups. Conclusion: Laparoscopy-assisted pancreaticoduo-denectomy for selected cases with duodenal papillary carcinoma is feasible and safe, and has a definite superiority over OPD. Caseswith a favorable tumor location and low body mass index were ideally suited to be treated with this surgical method.

     

/

返回文章
返回