摘要
目的探讨3D腹腔镜在胰十二指肠切除术中的临床应用价值，比较3D腹腔镜与开腹胰十二指肠切除术的临床疗效。方法采用回顾性队列研究方法。收集2014年7月至2016年3月华中科技大学同济医学院附属同济医院收治的349例行胰十二指肠切除术患者的临床病理资料。146例患者行3D腹腔镜胰十二指肠切除术设为3D腹腔镜组，203例行开腹胰十二指肠切除术设为开腹组。观察指标：（1）手术情况：手术时间、术中出血量、术中输血患者例数、淋巴结清扫数目、切缘情况、血管切除联合重建情况。（2）术后情况：胃管拔出时间、ICU人住时间、住院时间。（3）并发症情况：胰瘘、胃排空障碍、腹腔感染或脓肿、胆汁漏、出血、肺部感染或切口感染。（4）随访情况。采用电话方式进行随访，随访内容为患者无瘤生存率。随访时间截至2016年6月。正态分布的计量资料以x±s表示，组间比较采用t检验。计数资料比较采用X^2检验。结果（1）手术情况：两组患者均顺利完成胰十二指肠切除术。3D腹腔镜组与开腹组患者手术时间分别为（334±175）min和（320±91）min，术中出血量分别为（254±107）mL和（290±101）mL，术中输血患者例数分别为29例和35例，淋巴结清扫数目分别为（13±8）枚和（14±9）枚，切缘阳性分别为1例和5例，两组上述指标比较，差异均无统计学意义（t=0．975，1．383，X^2=0．390，t=12．155，X^2=1．589，P〉0．05）。3D腹腔镜组与开腹组患者术中联合血管切除重建分别为0和14例，两组比较，差异有统计学意义（∥=10．490，P〈0．05）。（2）术后情况：3D腹腔镜组与开腹组患者术后胃管拔出时间分别为（2．9±1．9）d和（5．1±1．7）d，ICU人住时间分别为（6．9±2．1）d和（7．4±1．2）d，住院时间分别为（12．9±7．2）d和（19．8±7．1）d，两组上述指标比较，差
denectomy （OPD）. Methods The retrospective cohort study was adopted. The clinicopathological data of 349 patients who underwent pancreaticoduodenectomy at the Affiliated Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between July 2014 and March 2016 were collected. Of 349 patients, 146 undergoing 3D-LPD were allocated into the 3D group and 203 undergoing OPD were allocated into the OPD group. Observation indicators ： （ 1 ） surgical situations ： operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected, resection margin and vascular resection and reconstruction, （2） postoperative situations： time of gastric tube removal, duration of intensive care unit （ICU） stay, duration of hospital stay, （3） complications ： pancreatic fistula, delayed gastric emptying, intra-abdominal infection or abscess, bile leakage, hemorrhage, pulmonary infection or wound infection, （4） follow-up. All the patients were followed up by telephone interview to detect the tumor-free survival rate up to June 2016. Measurement data with normal distribution were presented as x± s and comparison between groups was analyzed using the t test. Count data were analyzed using the chi-square test. Results （ 1 ） Surgical situations ： all the patients underwent successful pancreaticoduodenectomy. Operation time, volume of intraoperative blood loss, cases of blood transfusion, number of lymph node dissected and positive resection margin were （334 ± 175）minutes, （254 ± 107） mL, 29, 13 ± 8, 1 in the 3D group and（320 ± 91 ） minutes, （290 ± 101 ） mL, 35, 14± 9, 5 in the OPD group, respectively, with no statistically significant difference between the 2 groups （t = 0. 975, 1. 383, X^2= O. 390, t = 12. 155, X^2 = 1. 589, P 〉 O. 05）. Vascular resection and reconstruction were respectively applied to 0 patient in the 3D group and 14 patients in the OPD group, with a statistically significant difference
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2016年第9期907-912,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81071775、81272659、81101621）
同济医院科研基金（2015B001）
关键词
壶腹部疾病
胰十二指肠切除术
并发症
腹腔镜检查
3D技术
Periampullary diseases
Pancreaticoduodenectomy
Complication
Laparoscopy
Three-dimensional technique
